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CERTIFICATION <br /> The applicant, Oldcastle SW Group, Inc. , represented by Rich Umbel <br /> as, President , does herby certify that does herby certify that San Isabel Electric <br /> Association, Inc. (structure owner) shall be compensated for any damage from the proposed <br /> mining operation to the above listed structure(s) located on or within 200 feet of the proposed <br /> affected area described within the Reclamation Permit for Fransciscotti Pit # 2, File Number M- <br /> 2018-058. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority under the <br /> Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Mined Land <br /> Reclamation Act for Hard Rock, Metal, and Designated Mining Operations Any alteration or modification to this <br /> form shall result in voiding this form. <br /> ACKNOWLEDGED BY: — (Signature of Officer) <br /> Applicant Oldcastle SW Group, Inc. Representative Name: Rich Umbel <br /> Date: << I - t I Title: President <br /> STATE OF ) <br /> )ss. <br /> COUNTY OFr <)�L ) <br /> The foregoing was acknowledged before me this day ofS, , 20 i k,by <br /> as -�)S icG6i� of C'G e a6 Cr7vc��� <br /> sf HEIDI R. VEACH <br /> Commission Number 701199 <br /> My Commission Expires: My COMM 9 Expires <br /> Notary Public 'oww' January 14, 2024 <br />