A party who sends a document relating to a benefit contested case hearing to the division shall also deliver copies of the document to all other parties as provided in §140.9 of this title (Requests by Parties). Delivery shall be accomplished by presenting in person, mailing by first class mail, facsimile, or electronic transmission. The document sent to the division shall contain a statement certifying delivery. The following statement of certification shall be used: "I hereby certify that I have on this ______ day of ____________, _______, delivered a copy of the attached document to (state the names of all parties to whom a copy was delivered) by (state the manner of delivery)."