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PERMITTEE/STRUCTURE OWNER AGREEMENT <br /> M&G Pit Permit#M-1985-079 <br /> State of Colorado,Mined Land Reclamation(MLR)law requires the permit applicant(operator/permittee)to agree to <br /> reimburse the owner of any permanent man-made structure(s)within 200 feet of the permitted mining area for damage done <br /> to the structure(s)as a result of the permitted operation. <br /> Mann Lake Holdings LLC.believes AT&T shall own the following structure(s),located within 200 feet of the permitted <br /> mining area Fiber,Fiber Indicator Poles. <br /> Maim Lake Holdings agrees to reimburse you for any damage done to the listed structures as a result of the mining operation. <br /> Your acknowledging signature and a notary seal in the spaces provided below shall satisfy the MLR law requirement. Mann <br /> Lake Holdings certifies this agreement as follows: <br /> CERTIFICATION: The Applicant Mann Lake Holdings LLC represented by Joseph M.O'Dea ,as the Manager <br /> does hereby certify that AT&T shall be compensated for any damage from the proposed mining operation to the above <br /> listed structure(s)located within 200 feet of the permitted mining area described in the MLR Permit for the M&G Pit. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant:Mann Lake Holdings LLC,2027 W.Colfax Avenue,Denver CO 80204 <br /> Representative: Joseph M.O'Dea,Manager,303.562.2000 KATHRYN A DAYMUT <br /> Signature: Date: 10\1/4:1 r NOTARY <br /> STATE OF COLORADO <br /> NOTARY ID:19964015382 <br /> STATE OF Colorado ) MY COMMISSION EXPIRES APRIL 1,2018 <br /> )ss <br /> COUNTY OF Denver ) <br /> The foregoing was acknowledged before me this day o ,2017,by Joseph M. <br /> O'Dea as the Manager of Mann Lake Holdings,LLC. <br /> t. q I <br /> - I — ` V <br /> Notary Pu�1�'�.!`.+.+,,. ' _ �>t. . My Commission Expires: <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Contact name(print): <br /> Signature: Date: . <br /> STATE OF ) <br /> )ss <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this day of ,2017,by <br /> • <br /> Notary Public: My Commission Expires: <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL # 7O(S / ,5*)--o e o o 1 CO 1 tL 7 <br />