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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: Lynn M. Shults. Regulatory Manager, office-303-286-2247 <br /> Signature: tit Date: )7—/l �6 Cynthia Antrim <br /> Notary Republic, State of Colorado <br /> STATE OF Colorado ) ss My Commission Expires February 19,2020 <br /> COUNTY OF Adams ) Notary ID:20084005737 <br /> The foregoing was acknowledged before me this—ZZ day of Gl 2016, <br /> by Lynn M. Shults as Regulatory Manager of L.G. Everist, Inc. v� <br /> Notary Public: Z';,121Zi 1 s N Z�-z� My Commission Expires: <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: f� <br /> Structure Owner(s). PDC Energy. ly Contact name(print): <br /> Signature: / Date. O <br /> STATE OF 6_C?L,0CA`t>Q } PAUL F.MO NT 1ILLE <br /> )ss (N�otary <br /> OTARY PUBLIC-sTATE OF COLORADO <br /> COUNTY OF / ii,� ) Identification#20154035574 <br /> Commission Expires 9/9/2019 <br /> The foregoing was acknowledged before me this day of 6G-r, 2016, by <br /> Notary Public My Commission Expires: 1 ! <br /> Sit:^ S7R,; ,;RE OWNER Via CER IFIED 7C14 2870 0001 C81,7 9875 <br />