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� s <br /> 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 PVREA (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 Johnson <br /> Date --)/,(3 , 2017 Title VP Aggregates <br /> STATE OF <br /> ) Ss. <br /> COUNTY OF U4k ) <br /> The foregoing was acknowledged before me this day of , 20 ice-; by <br /> lMy Commission Expires: It I <br /> Notary Public <br /> ANDY RODRIGUEZ <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> My Commission Expires on.__ 1L <br />