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CERTIFICATION <br /> The Applicant, Mid-States Materials LLC (print applicant/company name), <br /> by Michael Dee Schirmer (print representative's name), as Executive Vice President (print <br /> representative's title),does hereby certify that Black Hills Energy (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 Ordway Pit (operation name), <br /> File Number M-2006-054 <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: 21L <br /> !J <br /> Applicant/72-'J ' ✓/ f Ad d lit),,1I CRepresentative Name/77;c Ael 4/. sc h,i,i 't <br /> Date A 3 .1 0 017 Title fiec I)Uf P)`c e " ��PS Oft 7 <br /> STATE OF 4 ryas ) <br /> ) ss. <br /> COUNTY O>(50113I1€ ) <br /> The foregoing was acknowledged before me this.rd day of ft-I-the/ , 20 by <br /> Witte' D. Scher, kas Fxecuhve Vice / es,a f tit id STATES kf e,Als,•LLC, <br /> ��L/J L My Commission Expires: l(/ /L -/ <br /> Notary Public <br /> 5L-1.,51-iter <br /> fa1 tic T F FY <br /> b ! <br /> E S'!a OF �J ^ ASn <br />