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CERTIFICATION <br /> The Applicant, IHC Scott, Inc. (print applicant/company name), <br /> by '7jj_6A__K4 _ (print representative's name),as V1.�C Pa.S,J �-t—r (print <br /> representative's title),does hereby certify that Colorado Department of Transportation(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 Collett Property Borrow Area (operation name), <br /> File Number M-2-11L- Os'. <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 /> Applicant IHC Scott, Inc. Representative Name-1"- \;,-A2r <br /> Date J ?��-� Title U.GL �St <br /> STATE OF CAtq-�J ) <br /> ss. <br /> COUNTY OFy�.ae. ) <br /> The for ing as acknowledgedbefore me this day of 20 ZS,by <br /> as v,I,( of iHc soon,inc. <br /> My Commission Expires: <br /> Not y Publics -�� <br /> MITZI REECE <br /> Notary Public <br /> State of Colorado <br /> Notary ID M 20184011940 <br /> My Commission Expires 05-09-2026 <br />