2011-10-04_PERMIT FILE - M2010071

• Permit No: M2010071
• IBM Index Class Name: PERMIT FILE
• Doc Date: 10/4/2011
• Doc Name: Compensation Agreements for Structure within 200 ft. of the Affected Area.
• From: Bruce Humphries, RPM, Inc.
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

CERTIFICATION
The undersigned, 1 (2 41 t +' h' 1 1 Qc (print name), lnK' (print
title), City of Lafayette does hereby certify that, to the extend authorized by law, Lafayette will
indemnify Tom Schwartz for any costs incurred resulting from damage to the above listed
structure located on or within 200 feet of the proposed affected area described within Exhibit A,
of the Construction Materials Mining Permit Application, Goose Haven Reservoir #2 - Complex
Expansion resulting from the proposed mining or reclamation activities.
City of Lafayette:
Name: F- p r : 1. , Title:
STATE OF COLORADO)
)ss
Boulder County )
The fore going was acknowledged before me this (p day of ` ec , 2011 by
(Name) t- rc"..t._ , as(Title) (cor , of the City of Lafay
My commission expires: t0 /dam jasat t
Notary Public
ACCEPTED BY: (Print Name) \ a/Vt , for
Tom Schwartz.
Signature:
, 2011.
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