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Revised 09/25 NP <br />15 <br /> <br />Exhibit E – Authorized On-Site Representative Form <br /> <br /> <br />(To be completed and submitted to County staff no later than seven (7) days prior to the <br />Festival. Do not include with executed Agreement. This document will be maintained as a <br />separate administrative record and is not published with the contract.) <br /> <br /> <br />Festival Name: ________________________________________ <br />Festival Dates: ________________________________________ <br /> <br /> <br />Event Organizer Representative(s): <br />• Name: _______________________________________________ <br />• Title/Role: __________________________________________ <br />• Mobile Phone Number: _________________________________ <br /> <br />(Optional second representative) <br />• Name: _______________________________________________ <br />• Title/Role: __________________________________________ <br />• Mobile Phone Number: _________________________________ <br /> <br /> <br /> <br />Nonprofit Co-Licensee Representative(s): <br />• Name: _______________________________________________ <br />• Title/Role: __________________________________________ <br />• Mobile Phone Number: _________________________________ <br />(Optional second representative) <br />• Name: _______________________________________________ <br />• Title/Role: __________________________________________ <br />• Mobile Phone Number: _________________________________ <br /> <br /> <br />Certification <br />The undersigned certify that the above individuals are designated as Authorized On-Site <br />Representatives for purposes of the Festival License Agreement with Orange County, and that <br />each has full authority to make binding decisions on behalf of the Licensee during the Festival. <br /> <br />Event Organizer: Nonprofit Co-Licensee: <br /> <br />__________________________ __________________________ <br />Name / Title / Date Name / Title / Date <br /> <br /> <br />Docusign Envelope ID: 3A980A68-71D0-474E-9F57-E0071DB85733