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CERTIFICATION <br /> The Applicant, Love(and Ready-Mix Concrete, Inc. (print applicant/company name), <br /> by Brad Fancher (print representative's name),as President (print <br /> representative's title),does hereby certify that Zayo band r i dth (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 Dunn Pit (operation name), <br /> File Number M 2021-059. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act 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 /> Loveland Ready-Mix j" <br /> Applicant Concrete, Inc. —Representative Name� 'cr- <br /> Date Z-/J - L2 Title President <br /> STATE OF OLOrwk ) <br /> I ,� )ss <br /> COUNTY OF {-QAIM ) I_ <br /> The foregoin was acknowledged before me this day of pt 20Z by <br /> Qjr le. as O of kip kazA &Lx t�nU� <br /> O My Commission Expires. NOV . �ZZ <br /> Ndlary Public �— <br /> JOAN E HORST <br /> Notary Public <br /> state of Colorado <br /> Notary!D#19944018967 <br /> My Commission Expires 11.21-2022 <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEGED BY: <br /> Structure Owner Name <br /> Date Title <br /> STATE OF ) <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this_day of 20_,by <br /> as of <br /> My Commission Expires: <br /> Notary Public <br />