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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(a),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.Buildings,outbuildings,utilities, fencing and other related items on the property. <br /> CERTIFICATION <br /> The Applicant,Crossfire Aggregate Services LLC,by Perry Neil,as Manager,does hereby certify that Jered Wagner <br /> (structure owner)shall be compensated for any damage from the proposed mining operation to the above listed <br /> structure(s)located on or within 200 feet of the proposed affected area described within Exhibit A,of the <br /> Reclamation Permit Application for Kelly's Pond Protect(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 Rock,Metal,and Designated Mining <br /> Operations.Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: (Signature) <br /> .applicant Crossfire Aggregate Services LLC Representative Name Perry Neil Title Manager <br /> STATE OF 6,61 ) <br /> " ,�� )ss. kik-P ADETTE YOUNG <br /> COUNTY OF LdA�° ) _ STATE of COLORADO <br /> The foregoing was acknowledged before me this day of .i;t >✓ 20� by Y 1 t� <br /> Perry Neil as Manage <br /> ��r��of Crossfire Aggre a¢ to Services LLC. <br /> � 'L, �.t I—z 4-x'V(. . My Commission Expires: 4LC..4 . 13rAr'?.2- <br /> Notary Public J <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEGED BY: ,a __`--�_ (Signature) <br /> Structure Owner _Name <br /> Date V <br /> Title 0-1.2"'er— <br /> STATE OF ) <br /> 1 ss. <br /> COUNTY OFIla— l %LA YTH SIMONS <br /> The foregoing was acknowledged before me this42 day of f_.2RFNOTAIRY <br /> PUBIIi <br /> S as Law+deuneic of 7 E OF GULOn.4i)� <br /> My Commission Expires: ID 20034042922 <br /> Notary blic ION EXPIRES MAY 13 2024 <br />