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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 Commission, its agents, officers, attorneys, or employees. Executed at California, on , 20—. APPLICANT REAL PARTY IN INTEREST (If different from Applicant) Signature: Signature: Title: Title: SUBMITTALS In order for this application to be processed,the following information needs to be provided: 1. Two copies 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. Five copies of an 8.5"x 11"or 11"x 17" reduction of the proposal map; 4. Three copies of a metes and bounds description of the affected territory; 5. One certified copy of the City Council and/or Special District Board Resolution of Application, or a petition making application to LAFCo (as appropriate); 6. Written permission from each affected property owner(or signature form); 7. One copy of the project environmental document(One Compact Disc if more than 25 pages); 8. One copy of the project Notice of Determination; 9. Three 8.5"x 11"copies of the Vicinity Map (if not included on the proposal map); 10. One copy of the plan for providing services along with a schematic diagram of water, sewer and storm drainage systems(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(Ag) 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 The undersigned hereby certifies that all LAFCo filing requirements will be met and that the statements made in this application are complete and accurate to the best of my knowledge. Date: (Signature) Print or Type Name: Daytime Telephone: Justification of Proposal Revised:6-3-10 Page 3 of 3