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COMP s ON DELIVE
<br /> SENDER: COMPLETE THIS SECTION
<br /> ■ Complete items 1,2,and 3. A. Signature ❑Agent
<br /> ■ Print your name and address on the reverse r-j
<br /> DtAddresse
<br /> so that we can return the card to you. Received (Prrnjed Name) G, Date of Deliver
<br /> ■ Attach this card to the back of the mailpiece, f
<br /> or on the front if space permits.
<br /> 1. Article Addressed to. D. Is delivery address different from item 1? ❑Yes
<br /> If YES,enter delivery address below: p No
<br /> Jean Johnson
<br /> Great American Insurance Compjiiy
<br /> 420 East South Temple, Suite 334-
<br /> Salt Lake City, LT 84111
<br /> 3, Service Type ❑Priority Mail Express(
<br /> ❑Adult Signature ❑Registered Mail'""
<br /> ❑Adult Signature Restricted Delivery O Registered Mail Restric
<br /> A Certified Mai3 Delivery
<br /> 9590 9102 3188 7 2 5 7580 80 ❑Certified Mail Restricted Delivery ❑Return Receipt for
<br /> ❑Collect on Delivery Merchandise
<br /> ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation
<br /> 2. Article Number(Transfer from service label) 00
<br /> Insured Mail ❑Signature Confirmation
<br /> 7016 2710 0000 2965 4059 ❑Insured Mad Restricted Delivery Restricted Delivery
<br /> (over$500)
<br /> PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return ReceiK
<br /> r Servite
<br /> Certified Mail service Provides the following benefits: •
<br /> stal
<br /> ■A receipt(this portion of the Mail I9bel), for an electronic return receipt,see a retail
<br /> ■A unique identifier for mailpiece "`�� associate for assistance.To receive a duplicate 7 CERTIFIED-rilcilWail •
<br /> ■Electronic ve s.f delivery OWIled— `�turn receipt for no additional fee,present this u7
<br /> MY
<br /> delivery. t arked Certified Mail receipt to the p t.
<br /> ■A record of de a associate. __
<br /> (including the recipient's 7 _ __, __--
<br /> signature)th d bM I d"44 -Restr ed delivery service,which provides $3.4 5
<br /> for a specdie d. deliv to the addressee specified by name,or Certified Fee:
<br /> Important Remin 10 addressee's authorized agent. - Return Receipt Fee: $P.T5
<br /> -Ad t signature service,which requires the
<br /> ■You may purchase rbfied Mall service with 'nee to be at least 21 years of age(not nJ
<br /> Rrst-Class Mail®,F -Class Package Service®, ,.,'available at retail). S 6.6
<br /> orPnortyMad•servi Total Postage & Fees: .7
<br /> C.5�✓v�l r�i,^ Adult signature restricted delivery service,which g
<br /> •Certified Mad service is avallable for requires the signee to be at least 21 years of age D 7
<br /> international mail. and provides delivery to the addressee specified
<br /> •Insurance coverage Is notavailable for purchase by name,or to the addressee's authonzed agent t, n I t n i n n P n ct a n o
<br /> with Certified Mad service.However,the purchase (not available at retail).
<br /> of "ed Mail service does not change the ■To ensure that your Certified Mail receipt is
<br /> i sn yrr ante coverage automatically included with accepted as legal proof of marling,it should bear a
<br /> n Priority Mail items. USPS postmark.If you would like a postmark on
<br /> ■For an additional fee,and with a proper this Certified Mail receipt,please present your
<br /> endorsement on the mailpiece,you may request Certified Mail item at a Post Office'"for
<br /> the following services: postmarking If you don't need a postmark on this D Jean Johnson
<br /> -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion
<br /> of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply p Great American Insurance Company
<br /> You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. i .
<br /> el tr a r p 420 East South Temple, Suite »0
<br /> � f� e rRoom 215,Denver,CO 80203
<br /> Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Salt Lake City. UT 84111
<br /> Ps Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 r`s:� ,au.S.0 i+*o.«..�.kc..gv..�.,-.— -,- --• '
<br /> USPS TRACKING#
<br /> First-Class Mail
<br /> Postage&Fees Paid
<br /> USPS
<br /> Permit No.G-10
<br /> 9590 940�-" 1498'7275 7580 80
<br /> United States •Ccnrinr: Please print your name,address,and ZIP+4®in this box*
<br /> Postal Service State of Colorado
<br /> Department of Natural Resources
<br /> Division of Reclamation, Mining& Safety
<br /> 1313 Sherman Street, Suite 215
<br /> Denver, CO 80203
<br /> Spec prnd-
<br /> L s- c,,,n File M JCW fC�j
<br /> 1
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