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<br /> P OAQUIN COMMUNITY DEVELOPMENT DEPARTMENT
<br /> - Acr ,
<br /> 4 SAN J
<br /> _ �J NT Y SUBDIVISION
<br /> Crreciri ss cyrows here .
<br /> FILE NUIMBERD
<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 t 7
<br /> L . e
<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 . Date
<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 /> u . 114D [=' MWI ter° :
<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 /> 13 . For any and all costs and expenses incurred by the County on accouni 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 flees 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 . DEFl= 0SFE :
<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 /> Edo In the event of a disagreement behl✓een 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 Claire 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 /> 1 , further , certify under penalty of perjury that I am ( check one ) :
<br /> r 3 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 /> Print Name : � ; � 3az r, '� a5 '�,' � r� � ti. Signature Date . '
<br /> Print P ! ametell 1, 4 it al�� � j '� �� Signature : L ,00� o'
<br /> Date :
<br /> Print Name : ; �'�' - - ° � � Signature : Date :
<br /> Print idame : Signature : Date :
<br /> Print Name : Signature : Date :
<br /> f ' ac ' e el ou, : 1
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