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CERTIFICATION <br /> United Companies, Inc. lint applicant/company name <br /> The Applicant, (print� S_ ), <br /> by )'J(? r T. J 16i iu' (print representative's name),as jj 1� f ,}QC . (print <br /> representative's title),does hereby certify that�j� i i C160 Y�( (stricture 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 ptnsuan(Jo 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 PF,RMIT APPLICANT <br /> r <br /> ACKNOWLEGED BY: <br /> Applicant �fJ � p/f/ f��Representative Name..A— <br /> Date Title VP ! ` �� se- <br /> STATE OF N I D r4'Gl t? ) <br /> ss. <br /> COUNTY OF ,V-Sq <br /> T e foregoing was acknowledged belfo, re me thisla day of 20 f by <br /> e\ �v My Commission Expires: �0/i� q, <br /> Notary Public�� <br /> FGENEVIEVE MARIE BLECHA <br /> RY PUBLIC <br /> F COLORAQO#19914003259 <br /> Ex ices April 4,2023 i <br /> i <br />