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CERTIFICATION <br />The Applicant, Fremont Paving & Redi-Mix Inc. ( <br />print applicant/company name), <br />byJohn P. Ary (print representative's name), as President ( <br />print <br />representative's title), does hereby certify that C o 1 o r a d o I n t e r s t a t e G a Tstructure owner) shall <br />company <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 Pueblo County Aggregate Project <br />File Number M-2016 -009. <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 />STATE OF Olotorad0 ) <br />ss. <br />COUNTY OF f IeYY,b4 ) <br />Representative Name <br />Title r e d o <br />The foregoing was acknowledged before me s a'day of , 2011, byc% <br />ihn • %R•, as Q u/ts r fes; FFyoferYUr t Lng o}— <br />Notary Pu lic <br />My Commission Expires: <br />REBECCA ELLIOTT <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID # 19984002037 <br />MY COMMISSION EXPIRES DECEMBER 16, 2019