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C PERMIT #' <br />SITE ADDRESS: <br />i, the Owner/Applicant/Licensed Well Drilleripump Contractor agrees to indemnify. detencl <br />the County and its officers, officials, employees, agents, boards, and commissions (collectively "County'? as follows: <br />1. Indemnity: <br />ims, demands, a <br />a_ From and against any and all clactions, proceedings, lawsuits, losses, damages, judgments andlor liabilities arising <br />on and applied for well or pump or to attack, set aside, void, or annul, in whole or in <br />out of, related to, or in connection with the appGcaii <br />the County, and any environmental review documents related to the applied for <br />part approval or denial of the applied for permit by <br />permit; <br />b. For any and all costs and expenses incurred by the County on account of any Claim, except where such indemnification is prohibited <br />by law, including but not limited to damages, cost, expenses, attorney's yfees,or gainst he County, and the County'stness costs that may be costs asserted byany <br />person or entity, private attorney general fees claimed by or awarded to any party g <br />in preparing an administrative record which are not paid by the 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 claim shall not relieve ma o any <br />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 have the authority to control <br />the litigation and make litigation decisions, including, but not limited to, the manner in which the defense is conducted. <br />conflict,with a of tnterest. or if I fail to <br />of <br />Ian ounty Claimeoasonably determines that f to promptly employ counselgrea onably satisfactory to the County, then County common counsel presents such counsel Imay utilize the Office of phe romptly un uel. sCounsel oefense employ <br />Y <br />separate outside counsel to represent or defend the Courtly, and t shat) pay the reasonable attorneys fees and costs of such coun�e . <br />ND THAT THE <br />RK WILL <br />BE <br />NE IN <br />JOAQU NY COUNTY ORDINANCES, STATE LAWS ,HAND RULES A IS DAPPLICATION AREGULATIONS. NIOALSO CERTIFYO THAT My REQUIRED EL ENSEWITH IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. J c/ <br />PROPERTYOWNER �'jjj/i,.nt /nom, (V DATE �✓ f <br />,!? �.' t� PRINT: <br />SIGN: <br />' L DRI UN R: �) <br />LICE ' PRINT: DATE <br />SIGN: ` <br />AUTAORIZATIQN .FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />I , hereby authorize <br />Print Namc o£Authcrizcd Agent <br />Name of C-57licetmed &ahoriiid Rcpre*'Mtive <br />to siva this San Joaquin County Well & Boring Permit Application on my behalf. I understand this authorization is valid for one year an <br />is limited to the work plan dated on the front page of this application. <br />W& IPump Pen t <br />Page 2 oF'— <br />FHD043-0510,5 !�02I <br />