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CERTIFICATION <br />The Applicant, APC SOUTHERN CONSTRUCTION CO. LLC (print applicant/company name), <br />byJames MacDonald <br />(print representative's name), as Project Manager (print <br />representative's title), does hereby certify thatHuerfano county — cx613 (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 FRANCISCOTTI PIT #2 <br />File Number M- <br />(operation name), <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 mortification to this form shall result in voiding this form. <br />ACKNOWLEGED BY: <br />Applicant ='��� � �{ {ern )Representative Name n k I <br />Date <br />STATE OF <br />ss. <br />COUNTY OF I ) <br />The foregoing was acknowjedged before e this day of ; , 2 , 20i'.of <br />Title V! l � f z D3 / L.►'1� <br />T G My Commission Expires: % �� L l <br />ota Public <br />ELIZABETH WHITESEL-DUTTON <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID 20014022842 <br />MY COMMISSION EXPIRES 07/24/2021 <br />