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CERTIFICATION <br /> The Applicant, Connell Resources, Inc. (print applicant/company name), <br /> John M. WarrenVice President of Operations (print <br /> by (print representative's name), as <br /> Town of Timnath <br /> representative's title), does hereby certify that (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 Timnath Connell Pit (operation name), <br /> File Number M-1999-050 <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 /> Connell Resources, Inc. Representative Representative Signature - " <br /> Date Title Vice President of Operations <br /> STATE OF CC} QdO ) Janessa Ekberg <br /> NOTARY PUBLIC <br /> ) SS. STATE OF COLORADO <br /> COUNTY OF n h° ) NOTARY 10 20194017780 <br /> MY COMMISSION EXPIRES Mav(K12(19, <br /> The foregoing was acknowledged before me this (p day oitrc,trioeir 2024, by <br /> Ucon\NcirTei1 as v K ceNcio i- of ad C: , - <br /> . L. y My Commission Expires: C 16)0 (j2D23 <br /> No ary Public <br />