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CERTIFICATION <br /> The Applicant, United Companies, Inc. (print applicant/company name), <br /> by ee-der 1 Sfer4 (print representative's name),as V PP,, /A<S�� V • (print <br /> representative's title),does hereby certify that bean- 0 t((1 ' � W (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 Otter Creek Pit expansion (operation name), <br /> File Number M-2012-050 . <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 /> ACKNOWLEG ! Y: <br /> Applicant Mil Representative Name � r J. $"/Cgridi71 <br /> Date Q—/8—/ `T Title j//' T Sec. <br /> STATE OF C'O ) <br /> )ss. • <br /> COUNTY OF/ng$A ) <br /> T e foregoing was acknowledged)p efore e this/9-14 day of Sep f eP4er ,20 /9,by <br /> --kV/J". as V,P, ���6Er. of (�oi,7te4-eoAliga4, . <br /> r-7, 4A My Commission Expires: j'/Ori/ y A 013 <br /> Notary Public f <br /> GENEVIEVE MARIE BLECHA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#199140032 <br /> M Commission Expires ;. 11_4,529023 <br />