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PERMITTEE/STRUCTURE OWNER AGREEMENT <br /> State of Colorado, Mined Land Reclamation (MLR) law requires the permit applicant(operator/permittee) <br /> to agree to reimburse the owner of any permanent man-made structure(s)within 200 feet of the permitted <br /> mining area for damage done to the structure(s)as a result of the permitted operation. <br /> L.G. Everist, Inc. believes PDC Energy. Inc. own the following structure(s), located within 200 feet of the <br /> permitted mining area: 5 -gas wells 5 flow lines Storage tank and gas separator. <br /> L.G. Everist, Inc. agrees to reimburse you for any damage done to the listed structures as a result of the <br /> mining operation. Your acknowledging signature and a notary seal in the spaces provided below shall <br /> satisfy the MLR law requirement. L.G. Everist, Inc. certifies this agreement as follows: <br /> CERTIFICATION: The Applicant, L.G. Everist, Inc., represented by Lynn M. Shults, as Regulatory <br /> Manager, does hereby certify that PDC Energy, Inc. shall be compensated for any damage from the <br /> proposed mining operation to the above listed structure(s) located within 200 feet of the permitted mining <br /> area described in the MLR Permit for Carbon Valley Resource (M-2001-017). <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant: L.G. Everist Inc. 7321 E 88th Avenue Suite 200, Henderson, CO 80640 <br /> Representative: L nn M Shults Re ulato Manager, office-303-286-2247 <br /> Signature: 1/( Date: 07-11-�6 Cynthia Antrim <br /> Notary Republic, State of Colorado <br /> STATE OF Colorado ) My Commission Expires February 19,2020 <br /> ) ss <br /> COUNTY OF Adams ) Notary ID:20084005737 <br /> The foregoing was acknowledged before me this day of 2016, <br /> by Lynn M. Shults as Regulatory Manager of L.G. Everist, Inc. <br /> Notary Public:c G rZ l �r �J2c My Commission Expires: - — � <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): PDC Energy, Inc. Contact name (print): <br /> Signature. Date: <br /> STATE OF ) <br /> ) ss <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of , 2016, by <br /> Notary Public: My Commission Expires: <br /> SENT TO STRUCTURE OWNER VIA CERTI['ICD MAIL # 7014 2870 0001 0807 9875 <br />