FV-164 905-Citrus Grown in FL. Confidential Background Statemen

REPRODUCE lOCAllY.

Form Approved- OMSNo. 0581..0189

Include form number end dste on ell reproductions.
u.8. DEPARTMENT' OF AORICULTUIE
AGRICUL ruRAL MARKE11NG SERVICE

CONFIDENTIAL BACKGROUND STATEMENT
FOR
CITRUS ADMINISTRATIVE COMMITTEE
PUBUC MEMBER/ALTERNATE (M.O. 90S)

NOTE: Information concerning nominees to be used by the Secretary of Agriculture in appointing Pubic Interest Members and
Alternates to Administrative Committees of Marketing Agreements and Orders.
Name

Telephone Number (Include Area Code)
E-Mail Address:

Mailing Address (Including ZIP Code)
Number of Years

1. State of Residency

_

_

industry

2. Are you or any member of your immediate family directly associated with the
No
financially or otherwise?
Yes

3. If you have an indirect relationship with the

industry, please explain.

4. Please list all public interest and service type organizations of which you are or have been a member and positions held with each
organization.

5. Are you willing to familiarize yourself with the industry and the provisions of the Marketing Agreement and lor Order with the understanding
that members of the industry and the staff of the committee would assist you in this familiarization process?
Yes_
No_
6.

Are you willing to spend the time necessary to represent the public properly on such committee?
Yes_
No_

7. Would you be willing to undertake an assignment with the news media or other interested group in explaining the marketing order as a
representative of the general public?
Yes_
No_
8. List any other special qualifications you may have, such as educational training, work experience, etc., which would enhance your
qualifications to serve.

Dale

FV-164

107.03) (Destroy previous editions)

(Signaturel

Marketing order committee members, in their official capacities, are prohibited from taking any action specifically designed to
influence legislation, including any attempt to influence public opinion concerning legislation. Committee members may not
communicate with any official of a State or Federal legislative body for the purpose of attempting to influence legislation.
Committee members are also prohibited from attempting to influence State or Federal government actions or pOlicies or those
of foreign governments, except as specifically authorized under the marketing order or expressly approved by the Secretary.
Committee members are specifically precluded from authorizing the expenditure of marketing order funds for the purpose of
attempting to influence legislation or government actions.
These same prohibitions apply to committee managers, staff, and contractors, except that committee managers may consult
with the Department of Agriculture employees during the pendency of informal rulemaking actions.
If marketing order committee or subcommittee members or committee employees are sued individually or jointly for errors in
judgment, mistakes or other acts either of omission or commission (except for acts of dishonesty, willful misconduct, or gross
negligence) in the conduct of their duties under the marketing agreement or order, they may be authorized legal defense by the
Department of Justice (DOJ). Alternatively, legal defense may be provided through private counsel, if recommended by the
Department of Agriculture (USDA) and approved by DOJ. USDA and DOJ enjoy an excellent working relationship with respect
to providing legal representation for committee members and employees, either by DOJ or through authorized private counsel.
USDA is committed to a comprehensive legal defense policy for all committee members and employees acting within the scope

Date

Signature

Note: The fooowingstatements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork ReductionAct of 1995. The
authority for requesting this informationto be supplied on this form is the AgriculturalMarketing Agreement Act of 1937, Sees. 1-19, 48 Stat. 31, as amended,
(7 U.S.C. 601-674). Fumishing the requested informationis necessary for the administrationof the marketing order program.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a vaUd OMS control number. The valid OMS control number for this information cooection is 0581-0189. The time required to
complete this information cooection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the coHection of information.
The U.S. Department of Agriculture (USDA) prohibits discrimination in aDits programs and activities on the basis of race, color, national origin, age, disabUity,
and where applicable, sex, marital status, famDial status, parental status, reHgion, sexual orientation, genetic information, political beUets, reprisal, or because
aDor part of an individual'sincome is derived from any pubUcassistance program (Not aDprohibited bases apply to aUprograms.) Persons with disab17ities
who require altemative means for communication of program information (BraD/e, large print, audiotape, etc.) should contact USDA 's TARGET Center at
(202) 720-2600 (voice and TOD).

To me a complaintof discrimination, write to USDA, Director, Office ofCivD Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, orcall
(800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.
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FV-164 Reverse (12.00) (Destroy previous editions)