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CERTIFICATION <br /> The Applicant, Martinez Western Constructors Inc. <br /> By Paul Martinez <br /> As Vice President, does hereby certify that Excel Energy, (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 D_u_cra_y 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 E <br /> App icar Representative Name <br /> Date Title \� <br /> e <br /> STATE OF <br /> ss. <br /> COUNTY OFbu�- ) <br /> The foregoin .was acknowledged before me this day of , 20 f , by <br /> .6 } ) aS ObCrk f P, of n > c-, (-, A rV a rs <br /> My Commission Expires: ca 02� <br /> Notary Public <br /> ANNE DUSTIN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20044009724 <br /> My Commission Expires March 18,2020 <br />