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CERTIFICATION <br />The undersigned, (r 6 L 14 5 (print name), tom c"-e (Print <br />title), City of Lafayette does hereby certify that, to the extend authdiized by law, Lafayette will <br />indemnify Frank D. & Kathleen P. Schwartz for any costs incurred resulting from damage to <br />the above listed structure located on or within 200 feet of the proposed affected area desaibed <br />within Exhibit A, of the Construction Materials Mining Permit Application, Goose Haven <br />Reservoir #2 - Complex Expansion resulting from the proposed milling or reclamation activities. <br />City of Lafayette: <br />r.A. <br />Name: (L^ Pk.It s <br />STATE OF COLORADO) <br />"1'7 <br />)ss <br />Signature: <br />Pt <br />/ 3 "fa/rAf‘ <br />, Title: INA ` rT� <br />Date: l - U , 2011. <br />'1 47110 if <br />Boulder County ) <br />The fore going was acknowledged before me this Co day o£ cry-. , 2011 b <br />(Name) L,..Jc ' t; as(Title) ( er , of the City o <br />My commission expires: lt1 at.. /do <br />Notary Pabite <br />P ,qaxik D, 5c47001 7 <br />ACCEPTED BY: (Print Name) /�/yf�/tcee,5c Z Title: ()pi e , for <br />Frank D. & Kathleen P. Schwartz. <br />2 of 2 <br />