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CERTIFICATION <br /> The Applicant, Bestway Concrete Company (print applicant/company name), <br /> by Mark Johnson (print representative's name), as VP Aggregates (print <br /> representative's title), does hereby certify that DCP Midstream (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 La Poudre Amendment - La Poudre Grave! Mine (operation name), <br /> File Number M-1983- 090. <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 Bestway Concrete Company Representative Name Mark Johnson <br /> Date 2017 Title VP Aggregates <br /> v <br /> 1 <br /> STATE OF r ) <br /> j COUNTY OF ss. <br /> The foregoing was acknowledged before me this 14 day of , 20_fl—, by <br /> as of <br /> My Commission Expires: �/Q <br /> Notary Public <br /> RODRIGUEZ <br /> NOTARY PUBLIC <br /> STATE OF COLORADOL::ANDY <br /> Commission Expires on L <br />