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z‘Nuelits4 a5 t „\ <br />SENDER: COMPLETE THIS SECTION <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 />2. Article Number <br />(Transfer from service label) <br />PS Form 3811, February 2004 <br />• Washington International Insurance Company <br />. 475 N. Martingale Road, Suite 850 <br />Schaumburg, Illinois 60173 <br />Domestic Return Receipt <br />UNITED STATES POSTAL: SERVICE <br />Certified Mail Provides: SpeC <br />■ A mailing receipt File tF <br />• A unique identifier for your mailiiiece _ (� <br />• A record of delivery kept by the Postal Service for two years <br />Important Reminders: El& tt try .,$ 7 ' .g5 —) I <br />• Certified Mail may ONLY be co fined with First -Class Mail® or Priority Mail®. <br />■ Certified Mail is not available for any class of international mail. <br />■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For <br />valuables, please consider Insured or Registered Mail. <br />• For an additional fee, a Return Receipt may be requested to provide proof of <br />delivery. To obtain Retum Receipt service, please complete and attach a Return <br />' Receipt (PS Form 3811) to the article and add applicable postage to cover the <br />fee. Endorse mailpiece "Return Receipt Requested'. To receive a fee waiver for <br />a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is <br />required. <br />■ For an additional fee, delivery may be restricted to the addressee or <br />addressee's authorized agent. Advise the clerk or mark the mailpiece with the <br />endorsement "Restricted Delivery". <br />■ If a postmark on the Certified Mail receipt is desired, please present the arti- <br />cle at the post office for postmarking. If a postmark on the Certified Mail <br />I ' receipt is not needed, detach and affix label with postage and mail. <br />IMPORTANT: Save this receipt and present it when making an Inquiry. <br />— PS Form 3800, August 2006 (Reverse) PSN 7530-02-0010-9047 <br />DRMS -1313 Sherman, Rm 215, De nver, CO 80203 <br />First -Class Mail <br />Postage & Fees Paid <br />USPS <br />Permit No. 0 -10 <br />• Sender: Please print your name, address, and ZIP +4 in this box • <br />State of Colorado <br />Department of Natural Resources <br />Division of Reclamation, Mining & caret,, <br />1313 Sherman Street, Suite 215 <br />Denver, CO 80203 <br />B &tZ aw, <br />Speck 5,55 <br />l+ile llaC - 03 <br />A. Signature <br />X <br />fi„ 111,,, 1 , 1, lIltil 11 1 rl trtrltt , tlr,lltt! {t, { <br />For delivery information visit our website at www:usps.cornt. <br />0 <br />COMPLETE THIS SECTION ON DELIVERY <br />s - -• - <br />Washington International Insurance Company <br />475 N. Martingale Road, Suite 850 <br />Schaumburg, Illinois 60173 <br />See Reverse for Instructions <br />Rett <br />(Endorsei <br />Restricts. __ . _. _ . __ <br />(Endorsement Required) <br />Total Postage & Fees' $ <br />❑ Agent <br />❑ Addressee <br />B. Received by Name) C. Date of Y CRUZ 7- <br />�' <br />D. Is delivery address different from Item 1 ?- ❑ Yes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />❑ Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise , <br />i ❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) <br />7009 2820 0003 5701 4705 <br />S. Postal Services., <br />CERTIFIED °MAIL; I RECEIP,, <br />( Domestic Malt Only; No lnsurange Coverage Provided) <br />6 aU�R <br />Certified Fee: c o d $� ..85 <br />Return Receipt F �e;� ,, <br />Total Postage & Fe `- $5.60 <br />q. <br />∎� <br />t <br />❑ Yes <br />102595 - 02 - M -1540 <br />o ' <br />r <br />