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CERTIFICATION <br /> The Applicant, Duran & Pearce Contractors Inc (print applicant/company name), <br /> by Derek Duran (print representative's name), as VP (print <br /> representative's title), does hereby certify that (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 Martin Pit 1-A (operation name), <br /> File Number M- 1990-140 <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 aecc ��.< .; Representative Name /� rJ <br /> Date Z�zz /(p Title Vf <br /> STATE OF <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this I,z day of r e , 20/4,, by <br /> as QC P.'Qre of <br /> JULIE WALLER <br /> My Commission Expires: NOTARY PUBLIC <br /> STATE OF COLORADO <br /> Y o ary Public NOTARY ID 201440398114 <br /> MY COMMISSION EXPIRES 10/10/2018 <br />