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AFFIDAVIT AND INDEMNIFICATION STATEMENT <br />STATE OF COLORADO ) <br />ss. <br />County of Weld ) <br />The undersigned Affiant is importing inert structural fill materials from a variety of locations within the <br />state of Colorado, to the Platte Valley sand and gravel mine operated by Aggregate Industries-WCR, Inc. <br />(AI) under Division of Minerals and Geology Permit No. M-1989-120, and located at 1859 N. U.S. <br />Highway 85, Brighton, Colorado. Affiant hereby certifies and affirms that said soils are clean and inert, <br />and that there are no known materials contained in said soils that would significantly affect the inert <br />nature of these soils, nor are there any acid forming materials or toxic producing materials in said soils_ _ <br />Furthermore, by signing this Statement, Affiant shall indemnify and hold harmless AI in the event <br />it should be determined that any soil provided to AI is contaminated with any regulated pollutant and/or <br />poses environmental harm. Affiant shall assume all liability and costs associated with the removal, <br />disposal, and negative impacts of any contaminated material provided to AI. <br />Dated this ~~~-Hay of ~~f ~~~ , 2005. <br />AFFIANT: <br />Broda's Inert Fill <br />Company Name <br />. ~~ ~ <br />Subscribed and sworn to before me this ~~ay of L ~~ , 2002 by <br />... /' ~.,~ll~-C/~J ~~~ , as C~/.~/~-~Q ~ , of .~~~ ~-1..~.~~ ~/1 <br />and official seal. <br />CAROLINE D. <br />L )HULL <br />l <br />Notary Public <br />'~ ~~ f ~ <br />My Co Aires: <br />