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CERTIFICATION <br /> The Applicant, Russell Larsen, Kilgore Companies, LLC dba Elam Construction(print applicant/company name), <br /> by Russell A. Larsen (print representative's name), as Chief Operating Officer (print <br /> representative's title), does hereby certify that A & G Partnership, LLLP (structure owner) shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br /> Permit Application for C Road Pit (operation name), <br /> File Number M-2016-050 <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 and <br /> the Colorado Mined Land Reclamation Act for Hard Rock,Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PE IT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant 4#L(j0&A (6ott0a+r1&,LLC ELM"' Representative Name 'Rv45Ett_ A L Ar-5wfA <br /> Co�s-tewr.>z o>� <br /> Date 051024 Z o 18 Title G 0, 0 <br /> STATE OF �Ologoi Do ) <br /> ) ss. <br /> COUNTY OF t AC--5A ) <br /> The foregoing was acknowledged before me this \ day of �o�.t , 2011 t by <br /> _�SS�LI �'.c`SeX► as ��Peca't,,;,.,O��e�!' of Ktic�re.0=m4wan.,j. LLC.Abic.- q-A ex...Coy-.at►macX:.a <br /> My Commission Expires: <br /> No@y Public <br /> JONI PATTON <br /> Noary Pubic-Sax of Coiorado <br /> Notary 10 20184005040 <br /> My commission Ezpres Jan 30 2022 <br />