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17. Inlet pipeline to Goose Haven #1 <br />18. Barn on the NW corner of the new property <br />19. Access road on the N and S sides of the property, Leyner- Cottonwood Lateral <br />20. Irrigation ditch on both sides of the new property <br />CERTIFICATION <br />The undersigned, v t. a . ► it �. A (print name), JS (C e e4' (print <br />title), City of Lafayette does ereby certify that, to the extent authorized b law, Lafayette will <br />indemnify City of Lafayette for any costs incurred resulting from damage to the above listed <br />structure located on or within 200 feet of the proposed affected area described within Exhibit A, <br />of the Construction Materials Mining Permit Application, Goose Haven Reservoir #2 - Complex <br />Expansion resulting from the proposed mining or reclamation activities. <br />City of 1 _ <br />-041. <br />Name: k ) ft' 7 . bfri t r44 Title: <br />STATE OF COLORADO) <br />)ss <br />Boulder County ) <br />The fore going was acknowledged before me this 4;23 day of- 5 2011 by <br />(Name)3cc1(c S . ,,Ilan , as (Title) kss. C , .d , of the City <br />My commission expires: I0/ I <br />t <br />Notary Public <br />ACCEPTED BY: (Print Name) 11Cui (els 6 Title: <br />City of Lafayette. <br />Signature: <br />, Date: <br />, 2011. <br />2 of 2 <br />