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CERTIFICATION <br /> The Applicant, Amrize West Central Inc., by Kevin Peart, as Senior Vice President, does hereby <br /> certify that the Town of Morrison shall be compensated for any damage from the mining operation <br /> to the above listed structure(s) located on or within 200 feet of the proposed affected area <br /> described within Exhibit A, of the Reclamation Permit Application for Morrison Quarry, File <br /> Number M-1973-021. <br /> This form has been approved by the Colorado Mined Land Reclamation Board <br /> pursuant to its authority under the Colorado Land Reclamation Act for the <br /> Extraction of Construction Materials and the Colorado Mined Land Reclamation <br /> Act for Hard Rock, Metal, and Designated Mining Operations. Any alteration or <br /> modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLE BY: /, <br /> Applicant Representative Name (wO I V\ real' + <br /> Date $ 1 H f ar Title S .h i W V I u p_ADR idcrt STATE OF (DU eV'D ) <br /> )ss. <br /> COUNTY OF 1. {v5in• ) <br /> The foregoingwas acknowledgeefore me this I`"E day of }+ , 20 OS,by <br /> }lk() r as rti VV V ICQ (fM of r 1Z, <br /> C' Aa.,(.` J f\_-.. My Commission Expires: 421 a I /act <br /> Notary Public <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEGED BY: <br /> Structure Owner Name <br /> Date Title <br /> STATE OF _ ) <br /> )ss. <br /> COUNTY OF _ <br /> The foregoing was acknowledged before me this day of ,20_, by <br /> as of <br /> My Commission Expires: <br /> Notary Public <br /> 2/2 <br />