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SAN 10AQUIN COMMUNITY DEVELGrJMENT DEPARTMENT
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<br /> ; -- SUBDIVISIO :.
<br /> FILE NUMBER:
<br /> LEVINE ACT
<br /> Effective January 1, 2023, California Political Reform Act of 1974, Government Code§84308, known I have read and understand
<br /> as the Levine Act, prohibits any San Joaquin County Board of Supervisor member from participating in that this application is
<br /> any agenda item involving a discretionary land use permit or other entitlements if the Board member subject to these provisions:
<br /> has received any political contributions from the owner, applicant,or agent for the owner or applicant M
<br /> totaling more than$250 in the 12 months before the decision (but not before January 1, 2023)and for
<br /> the 12 months following the decision.The Act also prohibits an owner,applicant,or agent for the owner Initial
<br /> or applicant from making a contribution of more than $250 to a member of the Board of Supervisors „
<br /> while the item is pending and for the 12 months following the date a final decision is rendered. ate
<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 harmless the County
<br /> and its officers,officials,employees,agents, boards and commissions(collectively"County")as follows:
<br /> 1. INDEMNITY-
<br /> A. From and against any and all claims, demands,actions, proceedings, lawsuits, losses, damages,judgments and/or
<br /> liabilities arising out of, related to, or in connection with the application and applied for project or to attack, set aside, void, or annul, in
<br /> whole or in part, an approval of the applied for project by the County,the adoption of environmental review documents related to the
<br /> applied for project, and any related development approvals or project 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 indemnification is
<br /> prohibited by law, including but not limited to damages, costs,expenses, attorney's fees,or expert witness costs that may be asserted
<br /> by any person or entity, private attorney general fees claimed by or awarded to any party against the County,and the County's costs
<br /> incurred 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
<br /> 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 have the
<br /> authority to control the litigation and make litigation decisions, including, but not limited to,the manner in which the defense is
<br /> conducted.
<br /> C. If the County reasonably determines that having common counsel presents such counsel with a conflict of interest,or if I
<br /> fail to promptly assume the defense of any Claim or to promptly employ counsel reasonably satisfactory to the County,then County may
<br /> utilize the Office of the County Counsel or employ separate outside counsel to represent or defend the County, and I shall pay the
<br /> 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 application,or
<br /> ❑ Legal agent(attach proof of the owner's consent to the application of the properties involved in this application)and have been
<br /> authorized to''file on their behalf,and that the foregoing application statements are true and correct.
<br /> ZA
<br /> Print Name l Qk6etJ MIdG Grrrx /nr;r—Signature: Date: 7 t -S
<br /> Print Nama: �� L Lf Signature: Date:
<br /> Print Name: Signature: Date:
<br /> Print Name: Signature: Date:
<br /> Print Name: Signature: Date:
<br /> 03/28/2023
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