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QSANL . COMMUNITY DEVELOPMENT DEPARTMENT
<br /> . OAUIN ZONING COMPLIANCE REVIEW — ROAD NAME OR CHANGE
<br /> COU iii Tl Y ----
<br /> _ r�
<br /> u , FILE NUMBER .
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<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
<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 /> 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 /> 0 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 /> -- ---- - - --- - ---- -------- --- - - — - - ---- ---/--- ---- ---
<br /> Print Name : Cassandra Rivera Signature : ► f ! Lam - t Date . a/ q) vf
<br /> Print Name :
<br /> Michael Rivera Signature : � f Date : `- � a L
<br /> Print Name : Shelby Lackey Signature : _ � LGC , t. /el- _ Date : -
<br /> � Y
<br /> i Print Name : Kaylyn GrljalVa Signature : e�t k. t , �' fDate : 3 � �
<br /> Madison Lackey
<br /> f
<br /> { Print Name : Signature✓ � c5 r� LC 1 / Date : 12- � f�
<br /> Page 2 of 2
<br /> 03/28/2023
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