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CERTIFICATION <br /> The Applicant, Connell Resources, Inc. (print applicant/company name), <br /> by John M. Warren (print representative's name), as. Vice President of Operations(print <br /> representative's title), does hereby certify that Maclean, Phillip K and Judy A(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 Lazy Two Pit (operation name), <br /> File Number M-2019-001 <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: <br /> Applicant Connell Resources, Inc. Representative Signature <br /> Date W22-141zo Title Vice President o(Operations <br /> STATE OF <br /> ss. <br /> COUNTY OF �-af-triAe ) <br /> The foregoing was acknowledged before m thisvday of_ 20�� , by <br /> - Wi_LL"a %$s UtCQ. Re-60urCes, Inc <br /> NZIZA�,*- ty1( o� My Commission Expires:_ 6P ��01 <br /> Notary Public <br /> JENNIFER UNDBLAD <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20144008302 <br /> MY COMMISSION EXPIRES FEB.21,2022 <br />