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Locally Grown <br />LICENSE AGREEMENT FOR PRODUCER CERTIFICATION <br />b. Upon termination of this agreement, due to expiration or to breech of Agreement, the rights and licenses granted <br />hereby to LICENSEE shall immediately terminate and LICENSEE shall immediately cease to use the Locally <br />Grown logo and related food campaign materials. <br />By (Authorized Signature) <br />Date <br />Name & Title of Person Signing (Please Print) <br />Farm Name (Please Print) <br />Street address <br />Phone number <br />E -mail address <br />Total acres Acres farmed <br />City, State, Zip <br />Fax number <br />F -5 <br />3[Page <br />Attachmen number 3 <br />Page 97 <br />