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An example Structure Agreement which meets the requirements of the Statutes is shown below. <br />Structure Agreement <br />This letter has been provided to you as the owmcr of a structure on or within two hundred (200) <br />feet of a proposed mine site. The State of Colorado, Division of Reclamation, Mining and Safety <br />("Division-) requires that where a mining operation will adversely affect the stability ofany significant, <br />valuable and permanent man -made structure located within two hundred (200) feet of the aEtected land, <br />the Applicant shall either: <br />a) Provide a notarized agreement between the Applicant and the Person(s) having an interest in the <br />structure, that the Applicant is to provide compensation for any damage to the structure; or <br />b) Where such an agreement cannot be reached, the Applicant shall provide an appropriate <br />engineering evaluation that demonstrates that such structure shall not be damaged by activities <br />occurring at the mining operation; or <br />c) Wh= such structurc is a utility, the Applicant may supply a notarized letter, on utility letterhead, <br />from the ovvner(s) of the utility that the mining and reclamation activities, as proposed, wil) have <br />"no negative effect" on their utility. ( Construction Alateriakr Rule 6.3.12 and Rule 6.4.19 etc Lard <br />RocklUetal l4lining Rule 6 3.12 and Rule 6. 4.20) <br />The Colorado tfned Land Reclamation Board ("Board") has determined that this form, if <br />property executed represem v an agreement that complies with Construction ei-taterkd v Role 6.3.12(a). <br />Ruk 6 4.194, and C R S § 34- 32.3- I15(4)(e) and with flard Rocklkletal Mining Rule 63.12(a). Rule <br />6.4.20(a), and t R-N Q 34- 32- II5(4)(d). This form is far the sole purpose of ensuring compliance with the <br />Rules and Regulations and shalt not make the Board or Division a necessw v parry to any private civil <br />lawsuit to enforce the terms of the agreement or create any enforcement ohligations in the Board or the+ <br />DMvion. <br />The following structures arc located on or within 248 feet of the propped affected area: <br />2. <br />3. <br />4. <br />S. <br />(Please lkl additional structures on a .ceparatc page) <br />