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CERTIFICATION <br /> The Applicant, Grand Island Resources, LLC (print applicant/company name), <br /> by Daniel Takami (print representative's name), as Manager not <br /> representative's title), does hereby certify that Boulder County, Colorado (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 Transfer of Operator/Cross Gold Mine/Caribou Mine (operation name), <br /> File Number M- 19JIZ 410 <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Art 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 &,Mb an4o Ri;st AIr URepresentative Name DgNIEL—ThYA! t t <br /> Date �Lci�E �DZD -- Title -- �.�.wu <br /> STATE OF / ) <br /> ss. <br /> COUNTY OF.&a ) <br /> Th foregoing was acknowledged before me this II�day of JUM6 20 aQ, by <br /> A)I � <br /> I —r bL> as CLA#JA �rt of rnnjo�-t, t AAJ0 Oc�i i1 L�,G <br /> My Commission Expires: <br /> Notary Public <br /> Can+ is Lam <br /> NOTARY PUMM <br /> 6TATE Of CO"WAOO <br /> NOTARY 10 2015403M31 <br /> Oommas N[>P11tl 3 Aw@ M n. <br />