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CERTIFICATION <br /> The Applicant, El Rancho Bondo placer mine (print applicant/company name), <br /> by Tom Zimmerman (print representative's name), as claim owner (print <br /> representative's title), does hereby certify that Rock and Rail (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 El Rancho Bondo CMC-278502 (operation name), <br /> File Number M-2018-028 . <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 BY: l <br /> Applicant ,t_.t �a� & 2 Representative Name-�mz t mnnkf 0.0ar-, <br /> Date K- I`J-I' Title Clatsn�i. OWP er- <br /> STATE OF ) <br /> ss. <br /> COUNTY OF ) <br /> The <br /> foregoing was acknowledged bbefore me thisday of 20 by <br /> I�rnZiMrn�rrc�r� as 1AiyM C�- 1nyat- o <br /> G1. My Commission Expires: aa, <br /> No Public <br /> TAM <br /> Stem <br /> 4 <br /> Ncj" 2 a,vW <br /> A*Y q11 E�P� <br />