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CERTIFICATION <br /> The Applicant, Loveland Ready-Mix Concrete, Inc., by George S Fancher, as Secretary, does <br /> hereby certify that Mathew A Tilley shall be compensated for any damage from the proposed <br /> mining operation to the above listed structure(s) located on or within 200 feet of the proposed <br /> affected area described within Exhibit A, of the Reclamation Permit Application for sand and <br /> gravel mining of the Knox Pit. <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 <br /> and the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining <br /> Operations. Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Applicant: Loveland Ready-Mix Concrete, Inc. <br /> Representative Name: George S Fanc er <br /> /Arimsp.77-, <br /> Representative Signature: WA i/ <br /> •i-- <br /> Date: February 23, 2018 <br /> Title: Secretary <br /> STATE OF COLORADO <br /> SS: <br /> COUNTY OF LARIMER <br /> On this 23 day of February ,2018,before me personally appeared, <br /> George S Fancher,known to me to be the persons whose names are subscribed to the above instrument and who <br /> acknowledged to me that they executed the same as their free act and deed. <br /> IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the day and year in this certificate <br /> first above written. �1 �1 <br /> MY COMMISSION EXPIRES: ►�J 0NI • d l -D t`Witness my hand an official seal. <br /> CSA i54 <br /> Notary Public <br /> JOAN E. HORST <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 19344018167 <br /> MY COMMISSION EXPIRES NOVEIRER 21 2018 <br />