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CERTIFICATION <br /> The Applicant, MCCORMICK EXCAVATION & PAVING LLC (print applicant/company name), <br /> byJIM MCCORMICK (print representative's name), asMANAGING MEMBER (print <br /> representative's title), does hereby certify that KIT CARSON COUNTY (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 MCCORMICK PIT 1 (operation name), <br /> File Number M-202(-017 <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: <br /> II <br /> Applicant (Yl�CC(m ielci�� (WOA.0(1 4 PCLUttl5I L Representative Name I 01(Cor m t(IC <br /> Date 3- (2- 249 7Title 0--)aiti0,,1-t0., mQrnk 0`' <br /> STATE OF 0 ckt(oA V ) <br /> ) ss. <br /> COUNTY OF V,(-Cn+ )O►'\ ) <br /> The foregoing was acknowledged before me this/$+>, day of ,h , 207J, by <br /> tam NV(cumtcic asmaux is Mre - c ofPAcw1m,cicEki_cooa -,on4P'covkL.S. Lie_ <br /> 1.-ij <br /> 1 / iii <br /> My Commission Expires:$ -CA-a( 3 <br /> Notary ublic <br /> ASHLEY L FESKE <br /> Notary Public <br /> State of Colorado <br /> Notary) #20194029274 <br /> M Commission Ex.fires 08-01-2023 <br />