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Structure Agreement <br /> This letter has been provided to you as the owner of a structure on or within two hundred(200)feet of a proposed mine site,the <br /> Kelly's Pond Project.The State of Colorado,Division of Reclamation,Mining and Safety("Division")requires that where a mining <br /> operation will adversely affect the stability of any significant,valuable and permanent man-made structure located within two <br /> hundred(200)feet of the affected land,the Applicant shall either <br /> a)Provide a notarized agreement between the Applicant and the Person(s)having an interest in the structure,that the Applicant <br /> 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 engineering evaluation that <br /> demonstrates that such structure shall not be damaged by activities occurring at the mining operation;or <br /> c)Where such structure is a utility,the Applicant may supply a notarized letter,on utility letterhead,from the owner(s)of the <br /> utility that the mining and reclamation activities,as proposed,will have"no negative effect"on their utility. <br /> (Construction Materials Rule 6.3.12 and Rule 6.4.19&Hard Rock/Metal Mining Rule 6 3.12 and Rule 6.4.20)The Colorado Mined Land <br /> Reclamation Board("Board')has determined that this form,if properly executed,represents an agreement that complies with Construction <br /> Materials Rule 6 3.12(a),Rule 6.4.19(a),and C.R.S.§34-32.5-115(4)(e)and with Hard Rock/Metal Mining Rule 6.3.12(a),Rule 6.4.20(o),and <br /> C.R.S.§34-32-115(4)(d) This form is for the sole purpose of ensuring compliance with the Rules and Regulations and shall not make the Board <br /> or Division a necessary party to any private civil lawsuit to enforce the terms of the agreement or create any enforcement obligations in the <br /> Board or the Division.) <br /> The following structures are located on or within 200 feet of the proposed affected area: <br /> 1.Roads,driveways,signage,utilities,fencing,and other structures on Parcel 595921100013 (aka Lob Lolly Pit) <br /> CERTIFICATION <br /> The Applicant,Crossfire Aggregate Services LLC,by Perry Neil,as Manager,does hereby certify that Steven Del and <br /> Joyce Wright(structure owners)shall be compensated for any damage from the proposed mining operation to the <br /> above listed structure(s)located on or within 200 feet of the proposed affected area described within Exhibit A,of <br /> the Reclamation Permit Application for Kelly's Pond Project(operation name),File Number M-2022- <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to Its authority under the Colorado Land Reclamation <br /> Act for the Extraction of Construction Materials and the Colorado Mined land Reclamation Act for Hard Rack,Metal,and Designated Mining <br /> Operations.Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERNIIT APPLICANT <br /> ACKNOWLEGED BY: -i _gc (Signature) <br /> Applicant Crossfire Aggregate Services L11C Representative Name Perry Neil Title Manager <br /> STATE OF i <br /> ss. BERNADEiTE YOUNG <br /> NOTARY PUBLIC <br /> COUNTY OF,�.e A1.4 A* } STATE OF COLORADO <br /> 8604 <br /> The foregoing was acknowledged before me this day of .a u�'r 20�.2 by My NOTARY ID t3,2022 <br /> Perry Neil as Manager of Crossfire Ageregate Services LLC. <br /> My Commission Expires: <br /> Notary Public F <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEGED BY: d ^F' K' g ature) <br /> StrUCtLWJVOwner Steven Del and Joyce Wri ht ' 257ijwl6wav 16 ARBOLES CO 81121 <br /> Name - cR.i wner <br /> STATE OF <br /> 1 ss. <br /> COUNTY OF r(I u',; '{c, I SOOTT WILLARO H@iZ <br /> The foregoing was acknowledged before me this day of 20't (by NOTWAJM <br /> yy ! C.,,(I to b ' �+ as Landowner of Parcel 595921100013, SMOF�MM <br /> My Commission Expires: v�� r�'' ' ';'L WC0WbSIM811ES,AlIEa3022 <br /> NotakyAilbric <br />