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7014 2120 0001 7871 1714 <br />U.S. Postal Service - <br />CERTIFIED MAIL° RECEIPT <br />Domestic Mail Only <br />For delivery information, visit our website at www.usps.com®. <br />(I <br />Postage: <br />Certified Fee: <br />Return Receipt Fee: <br />Total Postage & Fees: <br />Total Postage & Fees <br />$9,48544, <br />"'$3.45 — G <br />OCW <br />6.735 <br />Sent To <br />Street & Apt. No., <br />or PO Box No. <br />City, State, ZIP+4 <br />Ironshore Indemnity Inc. <br />12890 Lebanon Road <br />Mt. Juliet, TN 37122 <br />PS Form 3800, July 2014 <br />See Reverse for Instructions <br />