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CERTIFICATION <br /> The Applicant, Loveland Ready-Mix Concrete, Inc., by George S Fancher, as Secretary, does <br /> hereby certify that West Fort Collins Water District shall be compensated for any damage from <br /> the proposed mining operation to the above listed structure(s) located on or within 200 feet of <br /> the proposed affected area described within Exhibit A, of the Reclamation Permit Application <br /> for sand and 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, -r <br /> ` �' <br /> Representative Signature: ,i_efic <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. <br /> MY COMMISSION EXPIRES: i�+�✓ ( LC6itness my hand a d official seal. <br /> IfiCUE <br /> JOAN E. HORST • Notary Public <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 19934018A67 <br /> MY COMMISSION EKPIFES NOVEMBER 21,2011} <br />