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<1 <br />AGREEMENT FOR COMPENSATION BY MINING OPERATION <br />(MAN-MADE STRUCTURES WITHIN 200 FEET) <br />Colorado State law requires that man-made structures within 200 feet of a mining operation be <br />given special consideration. If the mining operation damages a man-made structure within 200 feet, <br />the mining operator will repair the structure, replace the structure, or compensate the owner of the <br />structure its fair market value. Maps in the vicinity of the proposed mining operation indicate that <br />you own a structure(s) within 200 feet of this proposed permit boundary. <br />Name / Type of Structure(s): MCI 11410 C I,6 <br />By signing this Agreement, the owner of the structure(s) acknowledges that they have been <br />informed of the permit application and agree to the arrangement of repair, replacement, or <br />compensation if the mining operation damages any of their structures as substantiated by proper <br />evidence and documentation. By signing this Agreement, the mining operator acknowledges their <br />responsibility as stated above. RECEjvED <br />Other Considerations: <br />W5 20 ILOA� <br />�cSa �tYidn, <br />�y;ning & <br />1N WITNESS WHEREOF, this Agreement is made this _ _ day of , 2015. <br />Landowner: A4 C mmuueAr/oNS 56aVICEs Imc. Mine Operato : Su e ents, LLP <br />By,_;/� By: <br />Print Name: M� J wiN PrinfName: , <br />Title: Title: <br />State of -7/ —ex As <br />) ss. <br />County of _ _ 1--),11141 } <br />The foregoing instrument was acknowledged before me this day of Ajo5l , 2015 <br />by k k5l%� Q r4- ascYe. r 1"7%% mytof Ma -6^01 U A ic. A Aa.s ,Services, 2-'7 C. <br />Witness my hand and official seal. Jimmy M irphree <br />Commission Expires <br />'a�or 03-13-2016 <br />My Commission expires: 2) 113 r 261(, <br />'Notar u llc <br />Page 1 of 2 <br />