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DocuSign Envelope ID: 571863E8-F892-43F0-B73F-4AB062ACBOBF XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> f) List of Board of Directors <br /> Provide the following information about each board of director's member: name, telephone <br /> number, address, occupation or affiliation of each member and the list must identify the <br /> principal officers of the governing body, and length of term. <br /> g) Solid Waste Program Fee (SWPF) Verification <br /> This fee finances Orange County's recycling and waste reduction program. Submit either a.) <br /> proof of payment of the agency's FY 2016-17 Solid Waste Program Fee, OR b.) a statement <br /> on agency letter head indicating exemption and specify the person(s), business, etc. that is <br /> responsible for paying this fee. <br /> DO NOT SUBMIT THIS PAGE 1/26/2017 11:10:15 AMII'age 31 r 31 <br />