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= SAN JOAQUIN COMMUNITY DEVEL ( WENT DEPARTMENT
<br /> SUBDIVISION
<br /> FILE NUMBER
<br /> APN 257 = 130 =02
<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 /> 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 ; 11,J � m
<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 Initis
<br /> or applicant from making a contribution of more than $ 250 to a member of the Board of Supervisors r , � 0 .
<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 /> 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 C { airr . 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 rnake litigation clecisions , 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 ouitside counsel to represent or defend the County , and I shall pay the
<br /> reasonable attorneys ' fees and costs of such counsel .
<br /> 1 , further , certify under penalty of perjury that I am (check one ) :
<br /> M 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 a ) plication statements are true and correct .
<br /> Michael A . Teicheira, Trustee of the Michael A. Teicheira Trust as spet forth in the Teicheira Revocable Trust dated March 17 , 2011 ,
<br /> 10 . 50167 % interest
<br /> Print Name : Michael A. Teicheira , Trustee Signature :
<br /> John C . Teicheira, Trustee of the John C . Teicheira Revocable Trust dated Deceriber 15, 2011 , 10 . 50167 % interest
<br /> Print Name : John C . Teicheira , Trustee Signature : �• � Date : I
<br /> Thomas C . Telcheira, Trustee of the Teicheira 2018 Revocable Trust dated October 11 , 201810 . 5 167% interest
<br /> Print Name : Thomas G . Teicheira Trustee Signature s .= Date :
<br /> g r
<br /> 2023-58 (Five of Five)
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