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CERTIFICATION <br /> The Applicant, Concrete Express, Inc., by Joseph 0' Dea, as General Manager, does hereby <br /> certify that the City of Arvada 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 Brighton Mine, File Number <br /> M-1977-436. <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 /> ACKNOWLEGED BY: <br /> Applicant Concrete Express, Inc. Representative Name(Signature) _ <br /> Date I / / fa ZEa Title Chief Executive Officer <br /> STATE OF Co orado <br /> )ss. <br /> COUNTY OF r ) <br /> The foregoing was acknowledged before me this /(o day of.4.41,441.47_ , 20 26 , by <br /> Joseph 0' Dea as Chief Executive Officer of Concrete Express, Inc. <br /> My Commission Expires: rJ(- Z6 ZU 2-4, <br /> Notary Public <br /> DUSTIN M HARPER <br /> NOTARY FOR STRUCTURE OWNER Notary ora <br /> State of Cololorado <br /> Notary ID t120224033250 <br /> ACKNOWLEGED BY: My Commission Expires 08-25-2026 <br /> Structure Owner Name(Signature) <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 />