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CERTIFICATION <br /> The Applicant, Robins Construction, LLLP (print applicant/company name), <br /> by Randall L. Robins (print representative's name), as Partner (print <br /> representative's title), does hereby certify that Jeanette Lucero (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 Robins Rock Pit (operation name), <br /> File Number M-2009-053 . <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,n �` "� Representative Name <br /> Date Title &-Vko-rft� <br /> STATE OF <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this 17f� day of 202 a, by <br /> QQrdcv !,t (- l�l �t nS as of <br /> My Commission Expires: <br /> Notary Public <br /> CATHERINE L QUINLAN <br /> Notary Public <br /> State of Colorado <br /> Notary ID•20174031 174 <br /> My Commission Expires 07-25-2021 <br />