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<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
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