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INDEMNIFICATION AGREEMENT As part of this application, applicant and real property in interest, if different, agreed to defend, indemnify, hold harmless, and release the San Joaquin Local Agency Formation Commission, its agents, officers, attorneys, and employees from any claim, action, or proceeding brought against any of the above, the purpose of which is to attack, set aside, void, or annul the approval of this application or adoption of the environmental document which accompanies it. This indemnification obligation shall include, but not be limited to, damages, costs, expenses, attorney's fees, or expert witness fees that may be asserted by any person or entity, including the applicant, arising out of or in connection with the approval of this application, whether or not there is concurrent passive or active negligence on the part of the San Joaquin Local Agency Formation Comm!s sion, its gents, officers, attorneys, or employees. Executed a 1 P7-1 California, on — �� top APPLICA REAL PARTY IN INTEREST (If different from Applicant) Signatur .- Signature: Tit Title: --------------------------------------------------------------------------------------------------------------------------------------------- S U BMITTALS In order for this application to be processed,the following information needs to be provided: 1. One copy of this Justification of Proposal, completed and signed with original signatures; 2. Five prints of a full-scale proposal map showing the affected territory and its relationship to the affected jurisdiction (Refer to Guide for Preparation); 3. One copy of an 8.5"x 11"reduction of the proposal map; 4. One copy of a metes and bounds description of the affected territory; I 5. One certified copy of the City Council or Special District Board Resolution of Application, or a petition making application to LAFCo(as appropriate); j 6. Written permission from each affected property owner(or signature form); 7. One copy of the project environmental document; 8. One copy of the project Notice of Determination; ' 9. One 8.5"x 11"copy of the Vicinity Map (if not included on the proposal map); 10. One copy of the plan for providing services (refer to Government Code Section 56653); 11. One copy of the Pre-Zoning map or description (as required by Section 56375); 12. One copy of the Statement of Open Space Land Conversion (refer to Section 56377); 13. One copy of the Statement of Timely Availability of Water Supplies (refer to Section 56668(k)); 14. One copy of the Statement of Fair Share Housing Needs (if residential land uses are included in the proposal)(refer to Section 56668(1)); 15. One copy of the project design (site plan, development plan, or subdivision map); 16. One copy of the Residential Entitlement Matrix form (if residential land uses are included in the proposal); and 17. Filing and processing fees in accordance with the LAFCo Fee Schedule and the State Board of Equalization Fee Schedule. Additional information may be required during staff review of the proposal. CERTIFICATION I The and rsigne hereby certifies 1,4t all LAFCo filing requirements will be met and that the state ism a in icati re complet and acc rate to the best of my knowledge. � Date: Q i Sig ature) Print or Type Name: u�1 t!/tvc�aytime Telephone: 4 Justification of Proposal Revised: 04-21-03 Page 3 of 3 I I I