KC-327 Dairy 6A Diary-6 Offer Forms/Price Support Cancellation Request

EXHIBIT A
March 7, 2006
See Reverse for Privacy Act, Public Burden and Nondiscrimination Statements.

KC-327 Dairy 6A

OMB Exempt

U. S. DEPARTMENT OF AGRICULTURE

(1-12-07)

Commodity Credit Corporation

DAIRY BULK OFFER FORM
FOR KCCO USE ONLY
VDR/PL _____________

FAX No. 816-926-6381
Contracting Officer
USDA-CCC-Kansas City Commodity Office
Domestic Procurement Division, Stop 8718
Dairy and Multi-Food Branch
P.O. Box 419205
Kansas City, Missouri 64141-6205

COM/PK ____________

1. Offer is subject to the terms and conditions of Announcement DAIRY 6
2. Product:

Butter

Cheese

PRICE

____________

WHSE

____________

Nonfat Dry Milk (NDM)

3. Total net quantity offered: ______________________________ pounds.
4. Type: __________________________ Pack: __________________________ Color (Cheese): __________________________ Tare Weight: __________________________
5. Was NDM made from Grade A milk?

Yes

No

6. Indicate if NDM product has been reprocessed because of prior positive salmonella:
7. Location of product when inspected by USDA:
8. Type of warehouse applicable product is stored in:

Offeror’s plant
Cooler

Yes

CCC-approved warehouse
Freezer

No
Non-CCC-approved warehouse

Dry

9. Name and location of plant/whse.: __________________________________________________________________________________________________________________
10. Truck shipping point: ___________________________________________________________________________________________________________________________
(Name)
(Address)
(City/State/ZIP)
10a. Rail shipping point: ___________________________________________________________________________________________________________________________
(If different than truck)
(Name)
(Address)
(City/State/ZIP)
10b. Mileage distance: _____________ 10c. Serving Railroad(s): _________________________________ 10d. Switching Railroad: ___________________________________
(Refer to Block 10 Instructions)
Certificate
Number
11.

20.

Grade
12.

No. of
Containers
13.

Net Weight
14.

Full business name of offeror, complete address, telephone,
FAX number, and Email:

NDM Heat
Treatment
15.

NDM Bag
Manufacturer
16.

Storage Paid
Thru Date
17.

Whse. Storage
Lot No.
18.

Manufacture
Date(s)
19.

20a. Name, complete address, telephone, FAX number, and Email of
person to receive “Notice to Deliver” if other than person submitting offer:

By signing the offer, the offeror understands that any fraudulent certification or misrepresentation in this offer will render offeror subject to criminal prosecution and civil frauds
liability.

21. SIGNATURE

21a. TITLE

21b. DATE

EXHIBIT A
March 7, 2006
See Reverse for Privacy Act, Public Burden and Nondiscrimination Statements.

KC-327 Dairy 6A (REVERSE)

OMB Exempt

U. S. DEPARTMENT OF AGRICULTURE

(03-07-06)

Commodity Credit Corporation

INSTRUCTIONS FOR DAIRY BULK OFFER FORM
1.

Offer is subject to the terms and conditions of Announcement DAIRY 6;

2.

Identify appropriate box of product being offered;

3.

Specify total net quantity in whole net pounds of the product offered;

4.

Specify the type, pack size, color (cheese), and tare weight. Marked net and tare weight per container of the product offered. NDM offered on basis
of the sampling report. (The number of containers may be estimated.);

5.

Specify yes or no if NDM was made from Grade A milk in a plant certified under the Procedures of the National Conference on Interstate Milk
Shipments (“NCIMS”) as a Grade A plant;

6.

Specify yes or no if NDM has been reprocessed because prior test results of product were positive for salmonella;

7.

Identify the product location when inspected and graded by Dairy Programs (DP), Agricultural Marketing Service (AMS), U.S. Department of
Agriculture (USDA).
a. Offeror’s manufacturing plant;
b. CCC-approved warehouse - (a warehouse approved by CCC and under contract with CCC for storage of the product being offered);
c. Non-CCC-approved warehouse - (a warehouse not approved by CCC and not under contract with CCC for storage of the product being offered);

8.

Identify the appropriate box whether product is in a cooler, freezer, or dry space warehouse at the time of submitting the offer;

9.

Specify the name and location of the warehouse and processing plant;

10. Identify the name and location of the shipping point if different from the plant, railroads serving the shipping point, and the railroad switching shipping
point. If shipping point is on a team track, offer shall identify location and distance from plant and shall contact KCCO, Traffic and Contract
Administration Branch to verify agreement on mileage prior to use of the team track locations and submission of freight invoices;
11. Specify grading certificate number for each carlot offered, except for NDM, the sampling and test weight report number (sampling report number may
be used);
12. Specify the applicable grade shown on each grading certificate;
13. Specify number of containers per grading certificate. NDM offered on basis of the sampling report. (The number of containers may be estimated.);
14. Specify quantity in net pounds or kilograms as evidenced by the total net weight on each grading certificate or on the NDM sampling report. Butter
and NDM will be offered in 25-kilogram containers. Cheese will be offered in 40-pound blocks and 500 pound barrels with weight marked as pounds.
(Weight marked as metric weights are optional.);
15. NDM - Identify spray process heat classification whether high, medium, or low heat (each offered carlot shall involve the same heat classification);
16. NDM - Identify name of the bag manufacturer;
17. Specify date through which storage has been paid by the offeror if the product offered is stored in a CCC-approved warehouse;
18. Specify CCC-approved warehouse product storage lot number;
19. Specify the product date(s) of manufacture for each lot;
20. Provide full business name of offeror, complete address, telephone and FAX number, and Email. Show name, address, telephone, and FAX number,
and Email of person to receive the “Notice to Deliver,” if other than the person submitting the offer.
21. Signature and title of person submitting the offer, and the date, or name and title of person authorized to execute an offer on behalf of the offeror.
PRIVACY ACT AND PUBLIC BURDEN STATEMENTS
The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting
the following information is 7 CFR, Chapter 1430. The information will be used to accept or cancel offers submitted by dairy processors under the milk price support program.
Furnishing the requested information is voluntary. Failure to furnish the requested information will result in nonconsideration. This information may be provided to other agencies,
IRS, Department of Justice, or other State and Federal Law enforcement agencies, and in response to a court magistrate or administrative tribunal. The provisions of criminal and
civil fraud statutes, including 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the information provided.
The authority for collecting the following information is Public Law 107-171. This authority allows for the collection of information without prior OMB approval mandated by the
Paperwork Reduction Act of 1995. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

NONDISCRIMINATION STATEMENT
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable,
sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived
from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program
information ( Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).
To file a complaint of Discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or
(202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.