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The undersigned, A.arr , Cpr K e (print name), 6 Pew. (print <br />title), Harry Corkle Const. does hereby certify that. Harry Corkle Const. will indemnify CDOT <br />for any costs incurred resulting from damage to the above listed structure(s) located on or within <br />200 feet of the proposed affected area described within Exhibit A. of the Construction Materials <br />Mining Permit Application. Corkle Construction Pit #2 (M2011 -033) resulting from the <br />proposed mining or reclamation activities. <br />Harry Corkle Const.: <br />Name: <br />STATE OF COLORADO) <br />)ss <br />Jackson County5 <br />The fore going was acknowledged before me this (1 day of A)oL , 2011 by <br />(Name) )-- „„, E C o r k [e . as(Title) C �,� n e Y . of the Harry Corkle Const. <br />My commission expires: <br />5. C . Title: <br />r‘/(4,Rci, <br />CERTIFICATION <br />Notary Public <br />ACCEPTED BY: (Print Name) /gym % % ),n ,1.vs ere” <br />Title:, ? F ai Ailf S' , for <br />the Colorado Dept. of Transportation. r e A) A 6 f <br />Signature: �.n-, /J00+4 -�.+-e-c , Date: // /4- , 2011. <br />