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CERTIFICATION <br />The Applicant, Server Land Ventures (print applicant/company name), <br />by Chris Serbousek (print representative's name), as President (print <br />representative's title), does hereby certify that City of Greeley Greeley Water (structure owner) shall <br />be compensated for any damage from the proposed mining operation to the above listed structure(s) <br />Iocated on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br />Permit Application for Harmony Windsor Site _ (operation name), <br />File Number M- - <br />This form has been approved by lire Colorado Mined Land Reclamation Board pursuant to its <br />authoritj, under the Colorado Land Reclamation Art for lire Extraction of Construction Materials and <br />the Colorado Mined Land Reclamation Art for Hard Racy, Metal, and Designated Mining Operations <br />Ani, alteration or modification to this form shall result in voiding this form. <br />NOTARY FOR PERMIT APPL <br />ACKNOWLEGED BY: <br />Applicant Serfer Larul Ventures <br />Representative N <br />Date Nov 15, 2017 Title Chris Serbousek, Managing Member <br />STATE OF COIOM&O ) <br />) ss. <br />COUNTY OF ) <br />he foregoing was acknowledged efore m this day of `�J V 20 � , by <br />_. b as of <br />A kk W1 M-) _ My Commission Expires: �� " <br />Notary PkVIT <br />JMNIFER UNDBIAD <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY 10 20004029048 <br />MY COMMISSION EXPIRES FEB 21. 2018 <br />