Chapter 10 - EXHIBIT 10C • ACKNOWLEDGMENT FORM FOR AGENT UNDER POWER OF ATTORNEY

• Jurisdiction: Colorado

EXHIBIT 10C • ACKNOWLEDGMENT FORM FOR AGENT UNDER POWER OF ATTORNEY

Acknowledgment Form for Agent under Power of Attorney

I, the undersigned Agent, execute this Acknowledgment Form, and by such execution do hereby affirm that I:

1. Have read the power of attorney signed by __________, as principal, on __________ [date] (the "PoA");

2. Understand that when I accept the authority granted under the PoA, a special legal relationship is created between the principal and me, and that this relationship imposes legal duties and responsibilities upon me;

3. Acknowledge that it is my obligation to understand my duties and responsibilities under the PoA and the law, including, but not limited to, Colorado Revised Statutes §§ 15-14-707 - 718;

4. Understand that this Form is not intended to replace legal authority or advice and that I may consult with a lawyer, possibly at the principal's expense, if I have questions about this form or my duties and responsibilities as Agent;

5. Understand that I must act in good faith, do nothing beyond the authority granted in the PoA and disclose in writing my identity as an agent whenever I act for the principal, except as otherwise instructed by the principal;

6. Understand that, unless the PoA states otherwise, I must also:

• act loyally for the principal's benefit;
• avoid conflicts that would impair

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