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CERTIFICATION <br /> The Applicant, Castle Rock Construction Company of Colorado, LLC(print applicant/company name), <br /> by Ralph Bell (print representative's name), as CEO (print <br /> representative's title), does hereby certify that Century Link (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 Brent Pit (operation name), <br /> File Number M_TBD _ <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 - Representative Name 7 <br /> g <br /> Date //� Title <br /> STATE OF Co Lo 2AbT.-) ) <br /> ) ss. <br /> COUNTY OF AC) <br /> The foregoing was cknowledged before me this 3 day of -'v A� , 20�, by <br /> _g h as C VCR of Cs s t (Z oc L Ca nS'�Va6u.V) <br /> C,6 g .Act&%%f o-f1- tro 1drJ-0, L--L(, <br /> _ QMy Commission Expires: <br /> Notary Public <br /> DAVID BROOKS <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 0 20154047623 <br /> MY COMMISSION EXPIRES DECEMBER 11.2019 <br />