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SAN 'lOAQUIN COMMt9NITY DEVELP�MENT DEPARTMENT
<br /> .___._C O V N'T.�_..__
<br /> ADMINISTRATIVE/CONDITIONAL USE PERMIT
<br /> G :�•ca ,.mss t�e�re. FILE NUMBER:
<br /> ' LEVINE ACT
<br /> Eff¢cbve January 1 2023, Cal forn a Political Reform Act of 1874, Gov ant Code§ 84308 k ow I have read and nderstand
<br /> s the Levine Act, prohibits any San Joaquin County Board of Supervisor m tuber from partic"pating In a [hat this appli atlon is
<br /> any agenda item involving a tliscre[ionary land use permit or other entitlements If the Board member ubjed io these provisions:
<br /> has recaivatl any pollLcal conKibutions from the o nor,applicant, or agent Tor Na owns or applicant �s
<br /> tofalin9 mora than $250 In iha 12 months before the decision(but noY bafor6 January 1,r2023)and for Initl I
<br /> the t2 months following She decision.The Act also prohibits an ownaq applicant, or agent for the owner
<br /> or applicant from making a co ntribu[Ion of more than$250 to a member of the Board of Supervisors � �Z 7
<br /> while[he Item is pending and for the 12 months following the data a foal tlacislon is r¢nderetl. Dales
<br /> AUTHORIZATIONSIGN/$TU RES
<br /> ONLY THE OWNER OP THE PROPERTY OR AN AUTH ORIZE6:AG ENT MAY FILE AN APPLICATION
<br /> I,the Owner/ApplicanVAgen[agrees to indemnify, defend(with c set r asonably approved by County), and M1old M1armlass[he County
<br /> and its officers,officials, employees, agents, boards and commissions(collectively"County")as follows:
<br /> 1. tNUEMNITY:
<br /> A. From antl agalnef any antl all claims, demands, aCNons, proceedings, 18 Wsuits, 108565, tlamag6a,judgments and/or
<br /> Iiabilifias a ising out of, related to, or in connection With the application and applietl for project or fo attack, sat aside.void, or annul, in
<br /> whole or in part, an approval of Sha applied for project by the Goun[y,the adoption of environmental review documents related to the
<br /> applied for project, and any rel a[etl development approvals or project conditions for tM1e applied far project(hereinafter•Claim"):
<br /> B. For any antl all costs antl expanses Incurred by the County on accoun<of any Claim, except where such intlemnification is
<br /> prohibitetl by law, 'including but not limited to damages, costs, expanses, ettomay's teas,or Expert witness costs tM1at may ba asserted
<br /> by any parson o entity, private attomeY 9aner0l Teasdaimatl byor awarded to any Party against the County, antl the County's costs
<br /> Incurred inpreparingan atlministrative record whicha a ndDpaitl by the petitioner.
<br /> C. Except as to the Gdunty's sola negligence or willful miscodtluct.
<br /> 2. DEFENSE:
<br /> A.Tha County may participate or tlirect the defahsa oT any Clelm. Tha County's actions in-0efensa of any claim shall not
<br /> relieve me of any obligation to Indemnify,defend, and holtl harml655 the County.
<br /> B. In the event of a tlisa9ra6mant between Goun[y and me regarding defense of any Claim.the County shell hav6 the
<br /> authority to control the Iitlgation and make litigation tlecisions, including,.but'not'limitatl to, Ihamanner fn which Iha.d6fensa is
<br /> conducted
<br /> C. If the County reasonably determines that having common counsalpresants such cou nsal with a cdnflict df interest,or If I
<br /> tail[o promptly assume the dBf6nse of any Glalm or topromptly employ counsaf reasonably satisfactory to the County,than County may
<br /> u[Ilize the Office of the County Gounsal or employ separate bu[side nouneal to represent or tlafentl the County, and I shall pay the
<br /> aasonabla attorneys'fees and costs of such counsel.
<br /> rl. further, certify untler penalty of perjury that I am(check one):
<br /> � Legal property owner(owner indutlas partner,trustee,trustoq or corporate officer)of the proparty(s)involved in this application, ar
<br /> eget agent(attach proof of the owner's consent to[h6 application of the properties Involved In this application)and have been
<br /> authorizatl to Flla on chair behalf, and that[ha foregoing application statements ere true end correM. ' /
<br /> Print Name:
<br /> j�Fy/h/-�G✓�/LS6NI Si9neiura: Date: T���Zy
<br /> Print Names: � Signatur Oats:
<br /> Prtnt Name: Signature: Dat6:
<br /> Print Names: 519 nature: Data:
<br /> Print Names: Signature: Oai6:
<br /> Page 6 of 6
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