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SAN.JOAQUIN COMMUNITY DEVELOPMENT DEPARTMENT
<br />....--COUNTY—
<br />..........
<br />ADMINISTRATIVE/CONDITIONAL USE PERMIT
<br />FILE NUMBER:
<br />LEVINE ACT
<br />Effective January 1, 2023, California Political Reform Act of 1974, Government Code § 84308, known
<br />I have read and understand
<br />that this application is
<br />as the Levine Act, prohibits any San Joaquin County Board of Supervisor member from participating in
<br />subject to thes rovisions:
<br />any agenda item involving a discretionary land use permit or other entitlements if the Board member
<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 />Initial
<br />the 12 months following the decision. The Act also prohibits an owner, applicant, or agent for the owner
<br />than $250 to a member of the Board of Supervisors
<br />y/yl/2,0113
<br />or applicant from making a contribution of more
<br />while the item is pending and for the 12 months following the date a final decision is rendered.
<br />Date
<br />AUTHORIZATION SIGNATURES
<br />ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION
<br />1, 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 />Counsel employ separate outside counsel to represent or defend the County, and I shall pay the
<br />utilize the Office of the County or
<br />reasonable attorneys' fees and costs of such counsel.
<br />1, further, certify under penalty of perjury that I am (check one):
<br />9 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: Daryl Vorne Signature: Date. 04/21/2023
<br />Print Name: Signature: Date:
<br />Print Name: Signature: Date:
<br />Print Name: Signature: Date:
<br />Print Name: Signature: Date:
<br />Page 6 of 6
<br />03128/2023
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