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Sep/20/2022 234'19 PM Kaiser Permanente 12345 111 SITE ADDRESS: 9156 Connlp Ave. __S!t0CklonlP5209 PERMIT #; Diol Dlan OEM ■■OrME MEMO MOEN y unr n■u■r �'� ■r��iii ■■■■ ` , � err■ ■■■■IL ■n■iiiii ■niOM ■■■ 9 ■n■=NMI=■ WOMEN ■EErn■ME ni■u■M IMMOMMER■n■■■ SOMEONE MOM= EMMOMMI ■n■■u■r ■u un■n■■■ rMnr RIMIMB, ; 1, the 0wriorlApplicantl1-leoneoa Wall Drillor/Pump Contractor agroos to Indemnity, defend Win counsel reasonably approved by County, end hold harmless the County and its offieoro, offlelalo, omploynoa, o©onte, boards, and cnmmisslons (collectively'County") as follows: 1, indemnity: a. Front and uguinat any and all claims, demands, actions, proceedings, lawsuits, Iessus, damages, judgments and/or liabilities arising out of, related to, or in connection with the cpplicetlian and applied for Well or pump or to attack, set aside, void, or annul, In whole or in part, approval or doniul of thu uppliod for pormit by tho County, and any environmental review documentu related to the applied for permit: b. For any and all cost, and expunaeu incurred by the County on occount of any Claim, except where such Indemnification is prohibited by IoW. Including but not limited to damages, costs, expenses, attorney's foes, or oxport witnoss costs that may be asserted by any person or entity, private attorney general foes claimed by or awarded to any party ugalnat tho County, and the County's coats Incurred in preparing on administrative record which aro not paid by the potltionor. c. Excopt as to the County's cola nogllgnnco or willful misconduct. 2. Defonse: a. The County may panicipoto or direct the :101060 o1 any Claim. The County's actions In dafanae of uny claim uhall not relieve me of any obligation to indemnity, defend, and hold hannlose tho Counly. b. In the Avant of a dinaoroomnnt bntwaon County And me reflarding defense of uny Claim, tho County shall hove the Authority to control the litigation and make litigation danlslons. Including, but not Ilmlted to, the munnor In which the defonao Is conducted. If County reasonably determines that having common counsel presents such counsol whh a confilct of Interest, or If I fall to promptly assume the dufenau of any Claim or to promptly employ counsel reasonably saliafactory to the County, than County may utilize the Office of the County Counsel or employ separate outslda counsel to reprasent or (intend the County, and I Shull puy tho roosonoble atiornoys' fens and cents of such counsel. I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH A4L WORKERS CO EN9ATION LAW PROPERTY R: ( Q h n SION: PRINT: 1 DATE ` (J L:Nst 1V l L.I. ,R 'LIMP 'USTRICTUR: 91aN: PkINT: Austin LoQCk CFO DATE 9/2012022 _ AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION hereby authorize Snmr ofP.57 Llttmed AmlmriJ Reyvrmr.�mrve Pini \nn_ ai AcdovLe! A�eri to sign this Sari Joaquin County Welt & Boring Yemiit .Application on my behalf. t understand this authorzation is valid for one year and is limited to the work plan dated on the front page of this application. GN1104146;1jI: 2131 Po;x. or' 'Ne;lr P-9 took