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M 1(4ia Iii <br />CERTIFICATION <br />The Applicant, Schmidt Construction Company, by Scott Davis, as Vice -President of Schmidt <br />Construction Company, does hereby certify that C' <br />Mn - <br />r <br />(print structure owner) <br />shall be compensated for any damage from the proposed mining operation to the above listed <br />structure(s) located on or within 200 feet Of the proposed affected area as defined in the htiller <br />Gravel Pit (M-1982-112) peimit documents. The map included in "Exhibit A-sa" of this document <br />shows the approximate locations Of all structures listed above as of February 5, 2018 when these <br />structures were identified on site. <br />NOTARY FOR PROSPECTIVE SUCCESSOR <br />ACKNOWLEDGED BY: <br />Successor: Schmidt Construction Company Representative Name <br />Date Title ♦ �� <br />STATE OF COLORADO ) <br />COUNTY OF E loe'5;o ) ss. <br />The foregoing was acknowledged before me this M� day of 20_, by <br />— as C" °f <br />"ri-ICKK rw <br />*40XD-- MY Commission Expires <br />Notary Public --WWAa_ <br />JE,:f=1 ;;rl,!TER VNIHITTINGTON <br />NO TARP PUBLIC <br />STATE OF C0LORADO <br />No:ary ID 20084022664 <br />a ;:cmn:issEun MxWres 613012724 <br />