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CERTIFICATION <br /> The Applicant, United Companies, Inc. (printyappliicant/company name), <br /> by P S.SQL f}'U-not (print representative's name),as Ur litsd-_ JP�. (print <br /> representative's tide), does hereby certify that driej"zrirk, (structure owner) shall <br /> p ) <br /> be compensated for any damage from the proposed min' g 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 slue!l result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT All <br /> ACKNOWLEGED BY: /�, i.�� ' <br /> Applicant (i1 t fe( a�,Q Representative Name fife J. s is,,,,ad <br /> Date g"ZZ—i7 Title ✓P/ f Sec . <br /> STATE OF CO ) <br /> )ss. <br /> COUNTY OF /L(e if ) <br /> we201 <br /> The foregoing was acknowledged befa�re me thiso� day of ' .� ,1 _,by <br /> OLALQ,CJ-St �lut,Y as _p /1.-- . &,,e..., of (.�.y leCt �bntrQild-es . <br /> ; - 41/4 , u 1 My Commission Expires: / al <br /> N•ary Public <br /> I. JULIE A. MALMBERG <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20054003624 <br /> My Commission Expires January 27,2021 <br />