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Varna Companies, Inc. <br />Office of Special Projects <br />8120 Gape Street Frederick, Colorado 80516 Telephone (303) 666 -6657 Fax (303) 666 -6743 <br />Statement of Understanding <br />Landowner of Adjacent Structure Statement: Our no-a: ized signature below testifies we <br />have been provided with and opportunity to review: <br />1) a Stability Analysis Report pertaining to the proposed Varra - Coulson Resource Project - <br />Regular Impact (112) Permit Application M- 2013 -064; and, <br />2) a Map showing the approximate relationship of our property and the potential for any <br />qualified significant, valuable and permanent man -made structure(s), which may occur <br />within 200 feet of lands affected within the proposed Varra- Coulson Resource Project - Regular <br />Impact (112) Permit Application M- 2013 -064. <br />Upon review of the available materials; <br />And understanding the relationship of any significant, valuable and pennanent man -made structures <br />under our ownership and which may stand within 200 feet of lands affected within the proposed Vat7a- <br />Coulson Resource Project - Regular Impact (112) Permit Application M -2013 -064; <br />Further, by our signatures, as notarized below, we concur that planned activities detailed in the <br />application for permit M- 2013 -064; do not impact our qualified significant, valuable and permanent <br />adjacent man -made structures; and to assure you that in the unlikely event damage occurs to your <br />strue ures as a direct result of our active operations, it will be compensated for, consistent with <br />estMished law. <br />ture of Adiacknt Landowner <br />Print Name <br />State of <br />ss. <br />County of C a'ad ) <br />/r /I <br />Date <br />13 <br />BRENDA TRUJILLO <br />Notary Public <br />° State of Colorado <br />Notary ID 19964014508 <br />,N a ommission Expires Sep 28, 2016 ' <br />The foregoing instrument was acknowledged before me this IS day of j "JC / ' <br />2013, by "YN ' lr� Ste-, ( U Wyt for C S r <br />1. Title <br />Company or Corporation /' / <br />Notary Public <br />My Comnussion expires: <br />2 <br />