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UNITED STATES POSTAL SERVICE First- lass Mail <br />;l Postage &Fees Paid <br />- USPS <br />Permit No. G -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 & Safety <br />1313 Sherman Street, Room 215 ' <br />Denver, CO 80203 Spec d�lk aS <br />File M - 1Q4�-1C <br />! „i,11=,t „J 11111,,, „ii,,,l,101Ji.L,i„11. it)...l.l,.t.l.l <br />Certified Mail Pvouldes: SpeC.G, r2f2f> <br />N A mailing receipt �c <br />■ A unique identifier for your mailpiece File 19• )M -) 4 9 Z - ) a <br />■ A record of delivery kept by the Postal Service for two years <br />Important Reminders: <br />■ Certified Mail may ONLY be comb ed 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 Return Receipt service, please complete and attach a Return <br />Receipt (PS Form 3811)`fo 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 i <br />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- 000 -9047 <br />DRMS -1313 Sherman, Rm 215, Denver, CO 80203 <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 />Washing on International Insurance Company <br />475 N. Martingale Road, Suite 850 <br />Schaumburg, Illinois 60173 <br />A. Signature <br />IS <br />o <br />Postage: <br />i <br />_Imams <br />; <br />,a Certified Fee: <br />$0.44 <br />$2,85 <br />E3 Return Receipt Fee: <br />$2.30 <br />P_ <br />Ln <br />rn Total Postage & Fees: <br />C3 (Endorsement Required) <br />t <br />M Restricted Delivery Fee <br />(Endorsement Required) <br />i r <br />F <br />� Total Postage & Fees <br />$ <br />ru <br />- <br />Sent F <br />C3 <br />Street Washington International Insurance Company -- <br />0 <br />or PC 475 N. Martingale Road, Suite <br />ciry'q <br />850 <br />Schaumburg, Illinois 60173 <br />X /,✓ / 13 Agent <br />%1.t8� ❑ Addressee <br />B. Received by ( nted NaQ C. Date of Delivery <br />6- <br />D. Is delivery address diffirinTMm item 1? ElYes <br />If YES, enter delivery address below: ❑ No <br />3. Service Type <br />❑ Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) n V.. <br />2. Article Number <br />(Transfer from service label) 7009 2 8 2 0 0003 5 7 01 4903 <br />PS Form 3811, February 2004 Domestic Return Receipt 102595-02 -M -1540' <br />y <br />