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CERTIFICATION <br />The Applicant, Riverside Aggregates, LLC (print applicant/company name), <br />by Rudy Torres (print representative's name), gas Member (print <br />representative's title), does hereby certify that Jack Evans (structure owner) shall <br />be compensated for any damage from the proposed mining operation to the above listed structure(s) <br />located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br />Permit Application for Fdededchs Pit 112 <br />File Number M -2010- 080. <br />(operation name), <br />This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br />authority under the Colorado Land Reclmnation Ad for the Extraction of Construction Materials and <br />the Colorado Mined Land Reclamation Ad for Hard Rock, Meta4 and Designated Mining Operations <br />Any aheration or modification to this form shall result in voiding this form. <br />MQTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant 91VE961M AW&iAA0.LLC Representative Name <br />Loy lcjw=E�5 <br />Date /. aC L t <br />STATE OF 7 <br />COUNTY OF O <br />�,oing acknowledged before me thi&;I, I —day of 20 by <br />�� _ ��� <br />My Commission Expires: r%12. //-5- <br />� < i� <br />FdF oo�,o <br />