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CERTIFICATION <br /> The Applicants IHC Scott, Inc. 1 r (print applicant/company name), <br /> by nut I 4V e VS (print representative's name), as V t(C PaS jO4t-,1--,'t' (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-2.1,1L- v I . <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'' <br /> o� t <br /> Date_I�1��-3 Title Vat- j res �� <br /> STATE OF CA V-,tJ ) <br /> ss. <br /> COUNTY OF ,", ) <br /> The foregoing was acknowledged before me thi day of 30" . , 20 7-3, by <br /> as V,1. of IHC Scott,Inc. <br /> ( ; { jQ t My Commission Expires: L" <br /> Nota y Public <br /> MITZI REECE <br /> Notary Public <br /> State of Colorado <br /> Notary ID#20184011940 <br /> My Commission Expires 05-09-2026 <br />