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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 Bearded Goat Development, LLC(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 Orchard Grove Industrial Pit ("23 1/4 Road Pit") (operation name), <br /> File Number M-1990-094 <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: 7 <br /> Applicant Elam Construction Representative Name <br /> 1. <br /> Date l l)'-I Title ijICeC- <br /> STATE OF C-o�oQco ) <br /> ss. <br /> COUNTY OF Me S o. ) <br /> --The foregoing was acknowledged before me this day of Cyr ' , 20AJ, by <br /> as Chef ca�.Cl ,tea(' of K,kba& %Xz'" llC�1�i <br /> My Commission Expires: �oaa- <br /> Notary lic <br /> JONIPATTON <br /> Notary Pub;ic-Sa:e of Colorado <br /> Notary ID 20184005040 <br /> My Comm ss on Expires Jan 30.2022 <br />