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CERTIFICATION <br />The Applicant, SPRAGUE STONE LLC (print applicant/company name), <br />by MATTHEW SPRAGUE (print representative's name), as VICE PRESIDENT (print <br />representative's title), does hereby certify that NSA (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 SPRAGUE STONE <br />File Number M- <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 Reclamation Act for the Extraction of Construction Materials and <br />the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. <br />Any alteration or modification to this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant /y1Oi,L+o V, 5� Representative Name , �'f <br />Date fC b /Z - 20 1 S— Title V f Pf -e 5; <br />STATE OF 0010raalo ) <br />/��� ) ss. <br />COUNTY OF �CZJ i/}7e/ ) <br />The foregoing was acknowledged before me this A- day of ' A -tear , 20 /.5, by <br />o5��� as ✓i oc of <br />i My Commission Expires: (�'�.ti': %91-5- <br />Notary Pu c <br />MINDY G ZSCHEILE <br />NOTARY PUBLIC <br />STATE Of COLORADO <br />NOTARY ID # 20074028586 <br />MY COMMISSION EXPIRES AUGUST 02. 2015 <br />