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CERTIFICATION <br /> The Applicant, Connell Resources, Inc. (print applicant/company name). <br /> John Warren President (print <br /> by (print representative's name), as (1p <br /> representative's title), does hereby certify that Outdoor Nation, LLC (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 /> 5J Pit <br /> Permit Application for _-- (operation name), <br /> File Number Iv1-2024_032 <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 Kris,form shall result in voiding this.form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWI.EGED BY• <br /> Applicant Connell Resources, Inc. Representative Signature <br /> Date l Z`�— — — Title •-.--.5% .7-- <br /> STATE 0 ) <br /> COUNTY oila1irY�JI) s <br /> The o-e ioing was ackno‘ ledged be he me,this d y of��� ' r---C#20 <br /> �', of ll0�[ ' ' ac_ <br /> my Commission Expires: CJ d `� _dog-"' <br /> ry P,tbli <br /> JENNIFER LINDBLAD <br /> Notary Public <br /> State of Colorado <br /> Notary ID#20144008302 <br /> My Commission Expires 02-21-2026 <br /> Page 2 of 3 <br />