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The u n d e r s i g n e d , F(G I . 11111195 (print name), 1"tp,+ �' (print <br />title), City of Lafayette does herebcertify that, to the extend authori by law, Lafayette will <br />indemnify Left Hand Water District for any costs incurred resulting from damage to the above <br />listed structure located on or within 200 feet of the proposed affected area described within <br />Exhibit A, of the Construction Materials Mining Permit Application, Goose Haven Reservoir #2 <br />- Complex Expansion resulting from the proposed mining or reclamation activities. <br />City of Lafayette: A ,._. <br />Name: 1 yawl t• Ptt i(' f s <br />STATE OF COLORADO) <br />)ss <br />Boulder County ) <br />Signature: <br />CERTIFICATION <br />, Title: Pa <br />Notary Public <br />ACCEPTED BY: (Print Name) (;fir t S ke rS <br />the Left Hand Water District. <br />The fore going was acknowledged before me this to day o, 2011 by <br />(Name) -c . Q19 ;AkIfa., , as(Title) (.or , of the City of Lafayette. <br />My commission expires: 1 1 0 1 : : : • / . 4 . t • <br />ate: J , 2011. <br />Title: hq • Iy1 J & t for <br />2 of 2 <br />