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i <br /> 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 Prolect.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 /> snall Inner <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 owners)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("hoard")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/Meta/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 Regukrtions 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. LUMEN,INC. <br /> 2. <br /> CERTIFICATION <br /> The Applicant,Crossfire Aggregate Services LLC,by Perry_Nell,as.ManaAer does hereby certify that LUMEN, <br /> INC. (structure owner)shall be compensated for any damage from the proposed mining <br /> operation to the above listed structure(s)located on or within 200 feet of the proposed affected area described <br /> within Exhibit A,of the Reclamation Permit Application for Kelly's Pond Proiect(operation name), File Number M- <br /> 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 Constnwtimr Materials and the Colorado Mined Land Reclamation Act for Hard Rack Meto4 and Designated Mining <br /> Operations.Any oiteradon or mod ykation to this farm shall result in voiding this form. <br /> NOTAIRY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: -+ (Signature) <br /> Applicant Crossfire Aggregate Sery ces LLC Representative Name Perms Neil Title Mannor <br /> STATE OF G 11 ) <br /> COUNTY OF/,Q P/q-�q ss. <br /> ) <br /> The foregoing was acknowledged before me this_,aday of -AjZ h e- ,20,U by SEAL <br /> Pen Neilas Manager of Crosfire AgMeate Services LLC. <br /> My Commission Expires: <br /> Notary Public BERNAD PUBLICE YYUNG <br /> N T Y FOR STRUCTURE OWNER STATE OF COLORADO <br /> NOTARY ID 20064000MM <br /> M1'DOMM" AIIOIIBT19 2122 <br /> ACKNOWLEGED BY; I k (Signature) <br /> Structure Owner C U H F�1 =.�,. Name 'c M <br /> Z� a <br /> Date 2Z�� _Title C„A 5 ryt.):un FrajG<4 <br /> STATE OF I I, ) <br /> 21 <br /> ss. <br /> _ COUNT_Y_O_Fl•. DA 1 ��Th ___ <br /> e foregoing was acknowledged before me this_day of ��n� 202Z ,by SEAL T <br /> as of <br /> ti My Commission Expires: 05 2023 <br /> 811SO0f610e,QI AI9VJ.ON ; <br /> 0M0100 dO 31VJS <br /> Oriand MVlDN <br /> 1 <br /> I <br /> i <br /> , <br />