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TY <br /> S A N 10 A Q U I N COM DM NIISTRAE VEL OND TNONDAE USE PERMIT <br /> ENT <br /> COUNTY <br /> FILE NUMBER: <br /> LEVINE ACT <br /> Effective January 1,2023, California Political Reform Act of 1974,Government Code§84308, known 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 <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 Initial <br /> or applicant from making a contribution of more than$250 to a member of the Board of Supervisors �291,o2f <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 /> I,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 /> 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 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 /> utilize the Office of the County Counsel or employ separate outside counsel to represent or defend the County,and I shall pay the <br /> reasonable attorneys'fees and costs of such counsel. <br /> I,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 application statements are true and correct. <br /> Print Name: Bennie Mar Chun Signature: t�.,.�-t Y Date: A 't <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 <br />