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I = Q� � N COMMUNITY DEVELOPMENT DEPARTMENT
<br /> - 1 C©U NTY-. SITE>APPtRO` ALIUSE PERMIT
<br /> .;. ._: Greatness •ows lore:
<br /> FILE NUMBER:
<br /> AUTHORIZATIONSIGNATURES
<br /> ONLY THE OWNER JOF. 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 /> foilaass:
<br /> i, ti13fl1✓NitSii3Y:
<br /> A.From and against any and ail ciaims,demands, actions,proceedings,lawsuits,fosses, 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 andall costs and expenses incurred by the County on account of any Claim,except where such
<br /> indemnification is-prohibited by law, including but riot limited to damages, costs, expenses, attorney's fees, or expert
<br /> witness costs that may be asserted by any person or entity,private attorney oenerat 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 /> PekW eT.
<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 representor
<br /> defend the County,and I shall pay the reasonable attorneys'fees and costs of such counsel.
<br /> 1,further,certify under penalty.of perjury that I am(check one):
<br /> 0 Legal property owner(owner includes partner, trustee,trustor,or corporate officer)of the property(sl 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: Lignature: Date: .
<br /> Print Name: Signature: Date:
<br /> Print Name: Signatures Date:
<br /> Print Name: Signature: Date:
<br /> Print Name: Signature: Date:
<br /> Page 6 of 6
<br /> 08/13!202'
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