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AGREEMENT FOR COMPENSATION BY MINING OPERATION <br />(MAN-MADE STRUCTURE WITHIN 200 FEET) <br />Colorado State law requires that man-made structures within 200 feet of a mining operation be <br />given special consideration. If the mining operation damages aman- made structure within 200 <br />feet, the mining operator will repair the structure, replace the structure, or compensate the owner <br />of the structure its fair market value. Maps in the vicinity of the proposed mining operation <br />indicate that you own a struchire(s) within 200 feet of this proposed permit boundary. <br />Name/Type of Structure(s): <br />By signing the agreement, the owner of the structure(s) acknowledges that they have been <br />informed of the permit application and agree to the arrangement of repair, replacement, or <br />compensation if the mining operation damages any of their structures as substantiated by proper <br />evidence and documentation. By signing this agreement, the mining operator acknowledges his <br />responsibility as stated above. <br />Other Considerations: <br />IN WITNESS WHEREOF, this agreement is made this day of , <br />Landowner: <br />By: <br />Name: <br />Title: <br />State of <br />County <br />ss. <br />Mine Operator: Lafarge West, Inc. <br />Officer of Corporation <br />The foregoing instrument was acknowledged before me this day of , <br />by_ <br />Witness my hand and official seal. <br />My Commission expires: <br />r <br />as <br />of <br />Notary Public <br />Page 1 of 2 <br />