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PERMITTEE/STRUCTURE OWNER AGREEMENT <br /> State of Colorado,Mined Land Reclamation(MLR)law requires the permit applicant(operator/permittee)to agree to <br /> reimburse the owner of any permanent man-made structure(s)within 200 feet of the permitted mining area Known as <br /> the Wertz Pit for damage done to the structure(s)as a result of the permitted operation. <br /> Oldcastle SW Group,Inc. dba United Companies believes Bent County own the followingstructure(s),located <br /> within 200 feet of the permitted mining area: County Road JJ. <br /> Oldcastle SW Group,Inc. dba United Companies,agrees to reimburse you for any damage done to the listed <br /> structures as a result of the mining operation.Your acknowledging signature and a notary seal in the spaces provided <br /> below shall satisfy the MLR law requirement.Oldcastle SW Group, Inc.dba United Companies certifies this <br /> agreement as follows: <br /> CERTIFICATION:The Applicant,Oldcastle SW Group, Inc. dba United Companies,represented by Tyra <br /> Bartuska,as CO—NM Group Environmental Manager,does hereby certify that Bent County shall be compensated <br /> for any damage from the proposed mining operation to the above listed structure(s)located within 200 feet of the <br /> permitted mining area described in the MLR Permit for the Wertz Mine(M-2022-024). <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant: Oldcastle SW Group,Inc.dba United Companies,2273 River Road,Grand Jct,CO 81505 <br /> Representative: Tyra Bartuska,CO—NM Group Environmental Manager,(970)697-7886 <br /> Signature: Date: <br /> STATE OF COLORADO ) <br /> )ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this day of , by <br /> Jason Burkey as the Environmental/Natural Resources Manager of Oldcastle SW Group, Inc. dba United <br /> Companies <br /> My Commission Expires: <br /> Notary Public <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): <br /> Signature: Date: <br /> Title: <br /> STATE OF COLORADO ) <br /> )ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this day of , by <br /> My Commission Expires: <br /> Notary Public <br />