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ryl l4V t VV i � <br /> 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 PERMIT APPLICANT <br /> ACKNOWLEGED 1�'��)6eull-�� <br /> Applicant k4L.W+ &(6^ kx1&,LCC ELM" Representative Name 'Rwe,5Eu- A L p.t-Swf4 <br /> Cb�Yi2uuerR ofv <br /> Date 05 e> Title <br /> STATE OF COIog*Do ) <br /> ) ss. <br /> COUNTY OF AC--5A ) <br /> The foregoing was acknowledged before me this day of 20$, by <br /> S�[tl fl.LCd`sex. as Ch,sJFO Q�c-��,,,;,.,O r of t(�k�re.c� .,,�,...�_ L�. a �L►�e. q-4 QX % <br /> My Commission Expires: <br /> No a Public <br /> =RjIb-Ic <br /> N <br /> f Colorado <br /> &WOJan 30.2022 <br />