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RECEIVED OCT 2 0 2021 <br /> An example Structure Agreement which meets the requirements of the Statutes is shown below. <br /> Structure Agree= <br /> This letter has been provided to you as the owner of a structure on or within two hundred(200) <br /> feet of a proposed mine site.The State of Colorado,Division of Reclamation,Mining and Safety <br /> ("Division")requires that where a mining operation will adversely affect the stability of any significant, <br /> valuable and permanent man-made structure located within two hundred(200)feet of the affected land, <br /> the Applicant shall either: <br /> a) Provide a notarized agreement between the Applicant and the Person(s)having an interest in the <br /> structure,that the Applicant is to provide compensation for any damage to the structure; or <br /> b) Where such an agreement cannot be reached,the Applicant shall provide an appropriate <br /> engineering evaluation that demonstrates that such structure shall not be damaged by activities <br /> occurring at the mining operation;or <br /> c) Where such structure is a utility,the Applicant may supply a notarized letter,on utility letterhead, <br /> from the owner(s)of the utility that the mining and reclamation activities,as proposed,will have <br /> "no negative effect"on their utility.(Construction Materials Rule 6.3.12 and Rule 6.4.19&Hard <br /> Rock(Metal Mining Rule 6.3.12 and Rule 6 4.20) <br /> The Colorado Mined Land Reclamation Board('Board')has determined that this form, if <br /> properly executed, represents an agreement that complies with Construction Materials Rule 6.3.12(a), <br /> Rule 6.4.19(a), and C.R.S.§34-32.5-I1 S(4)(e)and with Hard Rock/Metal Mining Rule 6.3.12(a),Rule <br /> 6.4.20(a), and C.R.S. §34-32-115(4)(d). This form is for the sole purpose of ensuring compliance with the <br /> Rules and Regulations and shall not make the Board or Division a necessary party to any private civil <br /> lawsuit to enforce the terms of the agreement or create any enforcement obligations in the Board or the <br /> Division. <br /> The following structures are located on or within 200 feet of the proposed affected area: <br /> 1. W 04et- 1 rnpbu N MI + <br /> 2. Ryr� <br /> 11i,11 <br /> 3. <br /> 4. l Ir <br /> 5. <br /> (Please list additional structures on a separate page) <br />