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10/31/2019 Annual Report ePermitting Signup-Google Forms <br /> Email address(es) of additional person(s) to notify on annual <br /> report/map/fee due date(s): <br /> By clicking "Agree" below, you opt in to ePermitting for report <br /> submittal, and consent that the Division may send any and all <br /> correspondence, notices, documents and information to you <br /> electronically, in all matters related to reports and fees for your <br /> Permit(s) and/or NOI(s). You further consent that you will use ePermit <br /> to send any and all correspondence, notices, documents and <br /> information to the Division in all matters related to reports and fees for <br /> your Permit(s) and/or NOI(s). You consent that documents submitted <br /> electronically to the Division have the same legal force and effect as <br /> paper documents. The Division reserves the right to send any or all <br /> electronic records to you in paper form to your current mailing address <br /> on file at its sole discretion. Your agreement to opt in to ePermit <br /> 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 <br /> immediately upon the Division's receipt of this signed Agreement and <br /> you may no longer receive paper documents from the Division <br /> pertaining to reports and fees for your Permit(s) and/or NOI(s). This <br /> Agreement, including the validity of any signatures or consents, any <br /> claims, or any disputes arising hereunder shall be construed in <br /> accordance with and governed by the Laws of the State of Colorado. <br /> Further, if the permit or NOI holder is a corporation, partnership, trust, <br /> etc., you state that you are authorized to act on behalf of the permittee <br /> or NOI holder. <br /> Q Agree <br /> Submitted 10/31/19, 9:22AM <br /> https://docs.google.com/forms/d/1 IrxOW3YTBh UgGtqfeXDsKSGkvVjwJ FE-9jmiKZU RFs/edit#response=ACYDBNizU-UyLihXxfknaL6HYMA0dCsR49... 4/5 <br />