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PERMIT APPLICANT/STRUCTURE OWNER AGREEMENT <br /> CERTIFICATION: The Applicant, Albert Frei and Sons, Inc., represented by Albert Frei, Jr., as <br /> President, does hereby certify that the Colorado Department of Transportation (Structure <br /> Owner) shall be compensated for any damage from the proposed mining operation (Walstrum <br /> Quarry M-1983-033)to the below listed structure(s) located on or within 200 feet of the proposed <br /> affected area described within Exhibit S-l: <br /> US Highway 6(and ROTS, Fiber Optic, and Electronic Warn injaSi,-n <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLED ED BY ICAN ert Frei and Sons, Inc., <br /> Signature: Date: O 3/6 <br /> Name: Albert Frei, Jr. <br /> Title: President <br /> MICHELLE A. STEIN <br /> STATE OF COLORADO ) State of Public <br /> olor do <br /> ss Notary ID#19994012130 <br /> COUNTY OF CLEAR CREEK ) My Commission Expires 08-26-2023 <br /> The foregoing was acknowledged before me this day of March, 2021, by Albert Frei, Jr. as <br /> President of Albert Frei and Sons, Inc. <br /> Notary Public: My Commission Expires: 43 0704A 3 <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWV_1d' ED U URE OWNER: Colorado De artme tof T ans ortation <br /> Signature: Date:Name (Pri ✓�_. <br /> Title: C' L�`c C— ►-� ,�,-z �.. <br /> EOTARY Fawn MacDougall <br /> PUBLIC <br /> STATE OF Co�O�-0.AY� ) RY IID 2018 OF O4018a°1 <br /> SSION EXPIRESAPRIL 27,2022 <br /> COUNTY OF <br /> 0 <br /> The foregoing was acknowledged before me this o1%day of A pC'� , 2021,by , <br /> e.n eVe l 66f) as the r of C'nloaLbo Dew-_of TranSDe 4A41,00 <br /> Notary Public: My Commission Expires: QDp % a�'. 020 a a <br /> Page 2 of 2 <br />