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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 Town of Windsor (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 Gravel 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 Johnso <br /> Date --?//[5 , 2017 Title VP AQgregates <br /> STATE OF (oLg-Aj,,r- ) <br /> ) ss. <br /> COUNTY OF GJJok ) <br /> The foregoing was acknowledged before me this day of Jk , 201 , by <br /> I11I1(k, 316) as MtNi%K. of <br /> My Commission Expires: 2.�1'1 <br /> Notary Public <br /> ANDY RODRIGUEZ <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> N <br /> My Commission Expires on1.1 <br />