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SITE ADDRESS:-� 4 Cit M x re KV — - PE<uttr #: <br />the County and 1!s offimrs, oPfidVw <br />a unti��p CM&ScW agrees m Indemnify, defend with �� <br />ployees, agents, boards, and commissions reeeonaby approved by Courky, and hold harmless1. Indemnity;� ��� as follows: <br />a. From and against any and a*1 claims, <br />out of, related to, or In connecdon with � Proceedings, <br />,damages, ludgmems and/or iiab(litim arising <br />part, <br />approval or denial d Uw appUsd for perm/[ the County, and ex Mr6wV K sat as*de, vdd, or annul, In wide or In <br />permit; >Y. any anvkonmental revlaw documarris relfted to the appled for <br />b. For any and <br />eU casts and expenses anincumed by the County on acmunt of any Calm, except where such fndemnUicatlon le prohibilted <br />M law. Including but rot Wnitad b damages, Dose, axpeneas, amomeYs fees or by any <br />Person or entity, private attorney gerxxst fees claimed or e"t res costa that maY be Mwerted <br />In PrOParfng an adminMratiw record vNirh ans not paid M any PAY against the Courtly, end the County's cost Incurred <br />G E=80es to the County, sole neg1Vwx a or W@U "*,conduct. <br />2. Defense: <br />e. The County may participateor direct the defense of any The <br />o to indart rRy. de%M' and hold harmless the Counttyy. Cotrrrtys actions In defense of any claim shall not room ms of any <br />b. to the event of a d mom <br />litigation <br />tretwsen Comty and me regarding defense of arty Claim. the authority to control <br />n CO�y reasonably determi nm and <br />st n oarrnon Vis' figpwawft, �'t not ilrtdoed w, lire matter in which ft d�ese Iu�� <br />any Claim or to Mmptly employ oaaasl he C cansst ' a wtrHc! e>< Metereat, or M I fel! to promptly assume the defense of <br />separate outside cam,d to represent or eiefo dCounty.shory �eiloun <br />the r e'sOw arr COw4 may uta the 011101+ of the County Counsel or employ <br />1 HEREBY CERTIFY ' fees and Costs of such counsel. <br />JOAQUIN COUNTY THAT I HAVE PREPARAp TFt18 APPLICATION AND THAT THE WORK YyILL 8E DONE IN <br />ACCORDANCE WITH SAN <br />ORDINANCES, STATE LAWS, AND RULER AND REGULATIONS 1 ALSO CERTIFY THAT My REQUIRED UC S IS <br />CWORKERS COMPENURRENT AND ACTIVE yNT}I ��pO A CONTRACTORS STATE LICENSE E�pARp ANp THAT I AlM IN COMPLIANCE 1NENITH /U1 <br />�ACT10N <br />810N: W&L ON POWATE PROPLwr. <br />LiCLPiat� n r r. n PRarr DATE <br />SM: r V <br />-- Q. <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />hereby authorize <br />t+ur of as'r r�.e Aoferyd „ <br />to sign this San Joaquin County Well h Bo lriottimofA --MM AM <br />is limited to the work plan dated on the front <br />Page <br />Application on trey behalf. I undetstaad this auHtoriution is valid for one year and <br />page of this application. <br />EHD043-M GWr= <br />rw2an <br />aw / h,R r.sk <br />