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CERTIFICATION <br /> The Applicant, Weld County Public Works (print applicant/company name), <br /> by Mike Freeman (print representative's name),as Chairman of the Board of County Commissioners(print <br /> representative's title),does hereby certify that Scott Koskle (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 Koskie Pit Amendment (operation name), <br /> File Number M-2014-024 <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 /> Applicant p epresentative Name Atilce Freetlert <br /> Date MAY 18 2020 �° Chair, Board of County Comtdssioners <br /> STATE OF o ) 1861 4V <br /> COUNTY OF WeA8 ) <br /> U� <br /> The foregoing was acknowledged befor shay of 20 0'10 by <br /> f Yl i Ke, C--ceaCY AA 1 as 0—A-W i r of +4� W[1d �r1+!i esd ord <br /> (2*VWn(niSSiord xS. <br /> My Commission Expires: OCD(G>3 I QZ�W <br /> ry Public <br /> C14LOEALEXANDRAREMPEL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY 10 20164024038 <br /> MY COMMISSION EXPIRES JUNE 23,2020 <br /> aoao- 19-1-1 <br />