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CERTIFICATION <br /> The Applicant, Martinez Western Constructors Inc. <br /> By Paul Martinez <br /> As Vice President, does hereby certify that Jay Ducray Property, (structure owner) shall <br /> be compensated for any damage from the proposed mining operation to the above listed <br /> structure(s) located on or within 200 feet of the proposed affected area described within Exhibit <br /> A, of the Reclamation <br /> Permit Application for Ducray Pit (operation name), <br /> File Number M-2018-018. <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 <br /> Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining <br /> Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWL <br /> A plicant v Representative Name <br /> Date /,Y/ Title <br /> STATE OF ) <br /> ) ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this 2# day of , 20 , by / <br /> R(A k-}2di{truZ as Ot-. egj�111U— of , ru r 4a�s <br /> —�My Commission Expires: 1 x< ; <br /> Notary Public <br /> ANNE DUSTIN <br /> ANNE DUSTINI, NOTARY PUBLIC <br /> NOTARY PUBI. STATE OF COLORADO <br /> STATE OF COLD:,/. >, NOTARY ID#20044009724 <br /> NOTARY ID#2004 a s. My Commission Expires March 18,2020 <br /> [MY Commission Expire:• <br />