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SAN 10AQUIN COMMUNITY DEVELOPMENT DEPARTMENT
<br /> COUNTY TIME EXTENSION
<br /> ('f a- n- s grew her
<br /> FILE NUMBER: PA" U qC0 1-1
<br /> AUTHORIZATION SIGNATURES
<br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION.
<br /> I, the Owner/Applicant/Agent agrees to indemnify, defend (with counsel reasonably approved by County), and hold
<br /> harmless the County and its officers, officials, employees, agents, boards, and commissions (collectively"County") as
<br /> follows:
<br /> 1. INDEMNITY:
<br /> A. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages,
<br /> judgments and/or liabilities arising out of, related to, or in connection with the application and applied for project or to
<br /> attack, set aside,void, or annul, in whole or in part, an approval of the applied for project by the County, the adoption of
<br /> environmental review documents related to the applied for project, and any related development approvals or project
<br /> conditions for the applied for project (hereinafter"Claim");
<br /> B. For any and all costs and expenses incurred by the County on account of any Claim, except where such
<br /> indemnification is prohibited by law, including but not limited to damages, costs, expenses, attorney's fees, or expert
<br /> witness costs that may be asserted by any person or entity, private attorney general fees claimed by or awarded to any
<br /> party against the County, and the County's costs incurred in preparing an administrative record which are not paid by the
<br /> petitioner.
<br /> C. Except as to the County's sole negligence or willful misconduct.
<br /> 2. Defense:
<br /> A. The County may participate or direct the defense of any Claim. The County's actions in defense of any
<br /> claim shall not relieve me of any obligation to indemnify, defend, and hold harmless the County.
<br /> B. In the event of a disagreement between County and me regarding defense of any Claim, the County shall
<br /> have the authority to control the litigation and make litigation decisions, including, but not limited to, the manner in which
<br /> the defense is conducted.
<br /> C. If the County reasonably determines that having common counsel presents such counsel with a conflict of
<br /> interest, or if I fail to promptly assume the defense of any Claim or to promptly employ counsel reasonably satisfactory to
<br /> the County, then County may utilize the Office of the County Counsel or employ separate outside counsel to represent or
<br /> defend the County, and I shall pay the reasonable attorneys'fees and costs of such counsel.
<br /> I, further, certify under penalty of perjury that I am (check one):
<br /> Legal property owner(owner includes partner, trustee, trustor, or corporate officer)of the property(s) involved in this
<br /> application, or
<br /> Legal agent(attach proof of the owner's consent to the application of the properties involved in this application) and
<br /> have been authorized to file on their behalf, and that the foregoing application statements are true and correct.
<br /> Print Name:LEO VaSCOnCEIOS Signature: ,efDate: 00/6/1-2—
<br /> Print
<br /> 02S ZZPrint Name: Signature: Date:
<br /> Print Name: Signature: Date:
<br /> Print Name: Signature: Date:
<br /> Page 2 of 2
<br /> Updated 02/02/2021
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