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CERTIFICATION <br /> The A licant, United Companies, Inc. (print .pplicant/company name), <br /> by FQ,kr S. SIe,proel(print representative's , as , S7 Yet • (print <br /> representative's title), does hereby certify that f I0i�1Xr( /+ S (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 /> ACKNOWLEGED BY: ,04 14.0:/ <br /> Applicant U rkt.kcI Cuyaities Representative Name ,4, .•r ✓ 5't c7d4 <br /> Date "L "l 9 Title vv/ . <br /> STATE OF ak/Wit ) <br /> ) ss. <br /> COUNTY OF ': A ) <br /> yl <br /> ThAforegoing was acknowledged bef re me thi9 day of 20M,by <br /> S 'eY�S `e`er ivu tcti as VP/r 51 of ( r 7)1(e0t)P.S <br /> • I Y l i �.. My Commission Expires: )•-, 2 - <br /> Notary Pub is <br /> JULIE A. MALMBERG <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20054003624 <br /> My Commission Expires January 27,2021 <br />