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5 <br />M2201- oLOo <br />Gr4l- <br />led Ma i i- CS Cancel <br />• Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />• Print your name and address on the reverse <br />so that we can return the card to you. <br />• Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />A. <br />❑ Agent <br />B. y in d Name) Gate of QeuVE <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />Enrique Topacio <br />American Contractors Indemnity Company <br />601 S. Figueroa Street Suite 1600 <br />Los Angeles, Ca 90017 3. Service Type <br />,Certified Mail® ❑Priority Mail Express'" <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ Collect on Delivery <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article asfer from 7012 3460 0000 6385 3462 <br />(transfer from service label) <br />PS Form 3811, July 2013 Domestic Return Receipt <br />Dostal Service,. <br />!TIFIFn MAILTM RECEIF <br />ru �, r <br />rn <br />Ln r <br />CO f'���- Sri 48 <br />postage: ;' s 30 <br />E3 Certified Fee: F)0 '70tmark <br />E3 Return Receipt Fee: <br />$6.48 <br />o Total postage & Fe a�'�spt <br />a rusiage & Fees $ <br />M <br />a Enrique Topacio <br />° American Contractors Indemnity Company <br />r` - <br />601 S. Figueroa Street Suite 1600 <br />Los Angeles, Ca 90017 <br />