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9/17/2019 Annual Report ePermitting Signup-Google Forms <br /> QUESTIONS RESPONSES <br /> Email address(es) of additional person(s) to notify on annual report/map/fee due date(s): <br /> By clicking "Agree" below,you opt in to ePermitting for report submittal, and consent that the <br /> Division may send any and all correspondence, notices, documents and information to you <br /> electronically, in all matters related to reports and fees for your Permit(s) and/or N01(s). You <br /> further consent that you will use ePermit to send any and all correspondence, notices, documents <br /> and information to the Division in all matters related to reports and fees for your Permit(s) and/or <br /> N01(s). You consent that documents submitted electronically to the Division have the same legal <br /> force and effect as paper documents. The Division reserves the right to send any or all electronic <br /> records to you in paper form to your current mailing address on file at its sole discretion. Your <br /> agreement to opt in to ePermit represents a single legal transaction as that term is used in C.R.S. <br /> § 24-71.3-105. Your agreement to opt into ePermit will become effective immediately upon the <br /> Division's receipt of this signed Agreement and you may no longer receive paper documents from <br /> the Division pertaining to reports and fees for your Permit(s) and/or N01(s). This Agreement, <br /> including the validity of any signatures or consents, any claims, or any disputes arising hereunder <br /> shall be construed in accordance with and governed by the Laws of the State of Colorado. Further, <br /> if the permit or N01 holder is a corporation, partnership,trust, etc.,you state that you are <br /> authorized to act on behalf of the permittee or N01 holder. <br /> Q Agree <br /> Submitted 9117119,6:40 AM <br /> https://docs.google.com/forms/d/1 IrxOW3YTBhUgGtgfeXDsKSGkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNh9bHPmsNKuoYBcrwk6O9VcXB85... 3/3 <br />