KC-331 Bulk Grain Procurement Offer Form

Form Approved - OMS No. 0560-0177

KC-331

U.S. DEPARTMENT

OF AGRICULTURE

NO.

Farm Service Agency

(3-16-98)

BULK GRAIN PROCUREMENTOFFER
In accordance with Announcement

- Ext.
FIRM )NAME

(ANNOUNCEMENT

KC-P-G-4, Invitation No.

KC-P-G-4

FORM
, dated

, 2002, the undersigned offers the following:

(
WHEAT
PER METRIC TON, FOR
FOB,
FUMIGATION
U.S. NO.2
O/B
CHARGES
AIR
DRAFT
UANTITY
(Metric Tons
5% More or Less at Contract Price)
WATER
DRAFT
IFAX
NO.
ISTATE
[TITLE
!ZIP CODE
LENGTH
Office and are valid for this offer.
SIGNATURE
CODE
NAMED
BERTH
RESTRICTIONS
MAXIMUM:
ELEPHONE
NO.
SHIPMENT
PERIOD
CITY
By
submitting
this
offer, offeror ARE
certifies
that the applicable certifications have been submitted to the Kansas City Commodity
ning of Offers."
LOAD
BERTH
RESTRICTIONS
(Refer
to
Announcement KC-P-G-4, Section 3, Paragraph C(h)).
I\DDRESS

-

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 14, 1496, Subchapter Band C. The information will be used to assess Bulk Grain Procurement Offers.
Furnishing the requested
information is required to be a responsive offer. Failure to furnish the requested information will result in a nonresponsive offer. 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.
Federal agencies may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Public
reporting burden for this collection of information 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.
Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the U.S. Department of Agriculture, Kansas City Commodity Office (OMB No. 0560-0177), Chief, Planning
and Analysis Division, Stop 8768, P.O. Box 419205, Kansas City, Missouri 64141-6205.

NONDISCRIMINATORY

STATEMENT

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political
beliefs, sexual orientation, and marital or family status. (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 TOO).
To file a complaint of discrimination. write USDA. Director. Office of Civil Rights, Room 326-W, Whitten Building,
or call (202) 720-5964 (voice or TOO). USDA is an equal opportunity provider and employer.

141h

and Independence

Avenue,

SW, Washington,

D.C. 20250-9410