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CERTIFICATION <br />The Applicant. Serfer Land Ventures (print applicant/company name), <br />by Chris Serbousek (print representativCs name), as President (print <br />representative's title), does hereby certify that Lake Canal Reservoir Co. (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 Harmony Windsor Site <br />File Number M - <br />(operation name), <br />This form has been approved by the Colorado Alined Laud Reclamation Board pursuant to its <br />authority under the Colorado Land Reclamation Act for the Extraction of Construction Alaterials and <br />the Colorado Alined Land Reclamation ,qct for Hard Rock, Aletal, and Designated Alining Operations <br />Any alteration or modification to this form shall result in voiding this form. <br />NOTARY FOR PERMIT ADPL <br />ACKNOWLEGED BY: <br />Applicant serer Tandyent'11r, Representative Int <br />Date Nov 15, 2017 Title rh,i G Se <br />STATE OF CD1 bnLh ) <br />) ss. <br />COUNTY OF.. ) <br />was acknowledgedfore his da} of 1 0-twr. - .2 t , by <br />as _�d of <br />&RIMNIN-51 I/ <br />. ! • <br />FIENINIFER LINDBLAD <br />TARY PUBLIC <br />OF COLORADO <br />Y 10 20004029048ON EXPIRES FEB 21, 2018 <br />