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CERTIFICATION <br /> The Applicant, Loveland Ready-Mix Concrete,Inc.,by George S Fancher,as Secretary,does hereby <br /> certify that Mathew A Tilley shall be compensated for any damage from the proposed mining <br /> operation to the above listed structure(s)located on or within 200 feet of the proposed affected <br /> area described within Exhibit A,of the Reclamation Permit Application for sand and gravel mining <br /> 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: Geor:e S Fan or – —7 <br /> _.— <br /> irw,.....---- ,,..... ., <br /> Representative Signature: or „,....dig4PM'srlafar <br /> / <br /> Date: March 7, 2018 <br /> Title: Secretary <br /> STATE OF COLORADO <br /> SS: <br /> COUNTY OF LARIMER <br /> On this 7th day of March ,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 <br /> who 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 /> 1900 <br /> MY COMMISSION EXPIRES: ik li , . Witness my hand an official seal. <br /> 1 Notary Public <br />