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N .I ;J Q COMMUNITY DEVELOPMENT DEPARTMENT
<br /> - ZONING COMPLIANCE REVIEW — ROAD NAME OR CHANGE
<br /> C O U Iii T T
<br /> FILE NUMBER:
<br /> - LEVI-1 ;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
<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
<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 /> S . 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 /> Print Name : Cassandra Rivera Signature : Date :
<br /> Print Name : MlChael RlVera Signature : `���/�_� Date :
<br /> Shelby Lackey
<br /> Lke
<br /> Print Name . Signature : _ h �C. � Date :
<br /> ! i' Kaylyn Grijalva 1 � '
<br /> Print Name : Signature : Lr L i G� 66 Date : Z-
<br /> Madison Lackey
<br /> 9
<br /> I Print Name : Si nature c i� L �� Date :
<br /> Page 2 of 2
<br /> 03/28/2023
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