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CERTIFICATION <br /> The applicant, Oldcastle SW Group, Inc. , represented by Rich Umbel <br /> as, President , does herby certify that the City of Aurora, CO (structure owner)shall <br /> be compensated for any damage from the proposed mining operation to the above listed <br /> structure(s), if any exist at the time of mining and are located on or within 200 feet of the <br /> proposed affected area described within the Reclamation Permit for Fairplay Site, Permit <br /> Number M-1982-086. <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: of Officer <br /> (Signature ) <br /> Applicant Oldcastle SW Group, Inc. Representative Name: Rich Umbel <br /> Date: �/'/z� / Title: President <br /> STATE OF <br /> )ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this6 day of 6��1 , 2021, by <br /> as ` iO���M of <br /> _-- My Commission Expires: 4i 0 �2s <br /> Notary <br /> TRACY L CAPUTO <br /> General Notary-State of Nebraska <br /> My Commission Expires Feb 15, 2025 <br />