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SITE ADDRESS: Z 76 b 5 <br />�( PERMIT <br />-rr �a„�uvensea uvea Unller/Pump Contractor agrees to <br />the County and its officers, officials, employees, agents, boards, and coindemnify, defend with counsel reasonabl <br />y a pproved by County, and hold harmless <br />mmissions (collectively °Coun <br />1. Indemnity: ty”) as follows <br />a. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages, judgments and/or liabilities arising <br />out of, related to, or in connection with the application and applied for well or pump or to attack, set aside, void, or annul, in whole or in <br />part, approval or denial of the applied for permit by the County, and <br />rmany environmental review documents related to the applied for <br />permit; <br />b. For any and all costs and expenses incurred by the County on account of any Claim, except where such indemnification is prohibited <br />by law, including but not limited to damages, costs, expenses, attorney's fees, or expert witness costs that may be asserted by any <br />person or entity, private attorney general fees claimed by or awarded to an <br />in preparing an administrative record which are not paid by the petitioner. y party against the County, and the County's costs Incurred <br />c- Except as to the County's sole negligence or willful misconduct. <br />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 relieve me of any <br />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 authority to control <br />the litigation and make litigation decisions, including, but not limited to, the manner in which the defense is conducted. <br />If County reasonably determines that having common counsel presents such counsel with a conflict of interest, or if 1 fail to promptly assume the defense of <br />any Claim or to promptly employ counsel reasonably satisfactory to the County, then County may utilize the Office of the County Counsel or employ <br />separate outside counsel to represent or defend the County, and 1 shall pay the reasonable attorneys' fees and costs of such counsel. <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND <br />JOAgUIN COUNTY ORDINANCES. STATE taws, <br />CURRENT AND ACTIVE WITH THE CALIFORNIA <br />WORKERS COMPENSATION LAWS. <br />PROPERTY OWNE <br />SIGN: <br />SIGN: <br />Aua RULES AND REGULATIONS. I ALWOROO WILL ISE <br />THDONAT MYACCORDANCE <br />L CENSESAN <br />I5 <br />CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />PRINT: Jennifer Teicheira DATE March 22, 2022 <br />-------- 7 !�/� <br />PRINT: 'VZ .Sc�U� DATE �J—ZCU L Z <br />I, AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />XWU0 orC-JLicensed Aulh0dZM R > hereby authorize <br />eprcxntnlive <br />Nf NI—.17 <br />tO sign this San Joaquin County Well & Boning Permit Application on my behalf. I understand this authorization is valid for one year and <br />is limited to the work plan dated on the front page of this application. <br />RM0006 to292021 <br />Page 2 of 2 <br />Well / Pump Petmi, <br />