__________________________
(FOR LAFCO USE ONLY)
1 SUPPLEMENT
ANNEXATION, DETACHMENT, REORGANIZATION PROPOSALS
INTRODUCTION: The questions on this form are designed to obtain data about the specific annexation, detachment and/or reorganization proposal to allow the San Bernardino LAFCO, its staff and others to adequately assess the proposal. You may also include any additional information which you believe is pertinent. Use additional sheets where necessary, and/or include any relevant documents.
1. Please identify the agencies involved in the proposal by proposed action:
ANNEXED TO DETACHED FROM
Barstow Fire Protection District_ __________________________ __________________________ ___________________________
__________________________ ___________________________
2. For a city annexation, State law requires pre-zoning of the territory proposed for annexation. Provide a response to the following:
a. Has pre-zoning been completed? YES NO
b. If the response to “a” is NO, is the area in the process of pre-zoning? YES NO Identify below the pre-zoning classification, title, and densities permitted. If the pre-zoning process is underway, identify the timing for completion of the process. _Public Facilities_________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________
3. For a city annexation, would the proposal create a totally or substantially surrounded island of unincorporated territory?
YES NO If YES, please provide a written justification for the proposed boundary configuration.
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
4. Will the territory proposed for change be subject to any new or additional special taxes, any new assessment districts, or fees?
__No (government owned)____________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________
(FOR LAFCO USE ONLY)
2 5. Will the territory be relieved of any existing special taxes, assessments, district charges or fees required by the agencies to be detached?
___No____________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________
6. If a Williamson Act Contract(s) exists within the area proposed for annexation to a City, please provide a copy of the original contract, the notice of non-renewal (if appropriate) and any protest to the contract filed with the County by the City. Please provide an outline of the City’s anticipated actions with regard to this contract.
__No___________________________________________________________________________ _______________________________________________________________________________ ______________________________________________________________________________
7. Provide a description of how the proposed change will assist the annexing agency in achieving its fair share of regional housing needs as determined by SCAG. ___N/A____________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________
8. PLAN FOR SERVICES:
For each item identified for a change in service provider, a narrative “Plan for Service” (required by Government Code Section 56653) must be submitted. This plan shall, at a minimum, respond to each of the following questions and be signed and certified by an official of the annexing agency or agencies.
A. A description of the level and range of each service to be provided to the affected territory.
B. An indication of when the service can be feasibly extended to the affected territory.
C. An identification of any improvement or upgrading of structures, roads, water or sewer facilities, other infrastructure, or other conditions the affected agency would impose upon the affected territory.
D. The Plan shall include a Fiscal Impact Analysis which shows the estimated cost of extending the service and a description of how the service or required improvements will be financed. The Fiscal Impact Analysis shall provide, at a minimum, a five (5)- year projection of revenues and expenditures. A narrative discussion of the sufficiency of revenues for anticipated service extensions and operations is required. __________________________
(FOR LAFCO USE ONLY)
3 E. An indication of whether the annexing territory is, or will be, proposed for inclusion within an existing or proposed improvement zone/district, redevelopment area, assessment district, or community facilities district.
F. If retail water service is to be provided through this change, provide a description of the timely availability of water for projected needs within the area based upon factors identified in Government Code Section 65352.5 (as required by Government Code Section 56668(k)).
CERTIFICATION
As a part of this application, the City/Town of _________________, or the ________________________ District/Agency, ____________________ (the applicant) and/or the _____________________ (real party in interest - landowner and/or registered voter of the application subject property) agree to defend, indemnify, hold harmless, promptly reimburse San Bernardino LAFCO for all reasonable expenses and attorney fees, and release San Bernardino LAFCO, its agents, officers, attorneys, and employees from any claim, action, proceeding brought against any of them, the purpose of which is to attack, set aside, void, or annul the approval of this application or adoption of the environmental document which accompanies it.
This indemnification obligation shall include, but not be limited to, damages, penalties, fines and other costs imposed upon or incurred by San Bernardino LAFCO should San Bernardino LAFCO be named as a party in any litigation or administrative proceeding in connection with this application.
As the person signing this application, I will be considered the proponent for the proposed action(s) and will receive all related notices and other communications. I understand that if this application is approved, the Commission will impose a condition requiring the applicant and/or the real party in interest to indemnify, hold harmless and reimburse the Commission for all legal actions that might be initiated as a result of that approval.
As the proponent, I acknowledge that annexation to the City/Town of ______________________ or the ____________________ District/Agency may result in the imposition of taxes, fees, and assessments existing within the (city or district) on the effective date of the change of organization. I hereby waive any rights I may have under Articles XIIIC and XIIID of the State Constitution (Proposition 218) to a hearing, assessment ballot processing or an election on those existing taxes, fees and assessments.
I hereby certify that the statements furnished above and the documents attached to this form present the data and information required to the best of my ability, and that the facts, statements, and information presented herein are true and correct to the best of my knowledge and belief.
DATE _________________ _________________________________________________
SIGNATURE
_____________________________________________________
Printed Name of Applicant or Real Property in Interest
(Landowner/Registered Voter of the Application Subject Property) _____________________________________________________
Title and Affiliation (if applicable)
/REVISED: krm – 8/19/2015