KC-327-RSCS RSCS Offer Form

See Page 4 for Privacy Act, Public Burden, and Nondiscrimination
LOCATION/
LOCATION/
KC-327 -RSCS LOCATION/
BID
BID
PRICE
BIDPRICE
PRICEI
I
PRICE
LOCATION/ II I BID
I

Statements.

ITEM NO.
NO.VENDOR
PAGE NAME
ITEM
ANNOUNCEMENT NO. I INVITATION NO.
II II I

1

RSCS1

Subject
to the terms and conditions of this invitation and Announcement
I
I

I

I

I

I

I

I
I

RSCS 1, the undersigned offers to

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Act. Public Surd,
_ n

__

••

__

•

__

or

___

d Nondiscrimination

VENDOR
NAME NO.PAGEANNOUNCEMENT
INVITATION

Stat

2

NO.

RSCS1

$

2.

Price Range: From

3.

Total quantity offered

4.

Timely Performance (Check One)
has not
A The offeror has
prior to this bid opening.
B.

5.

To

$

(For Administrative

Purposes Only)

pounds.

0

0

0

0

The offeror has
has not
prior to this bid opening.

paid for all products under contracts with CCC that have a payment due date

converted all NOM under contracts with CCC that have a conversion deadline

INDEPENDENT PRICE CERTIFICATION
Check appropriate certification for either subparagraph 4. B. OR 4. B. (1) and (2) of Announcement

o
o

B.

RSCS1.

The offeror is the person in their organization responsible within that organization for the decision as to the
prices being offered and has not participated, and will not participate, in any action contrary to subparagraphs
A(1) through A.(3) of Announcement RSCS1, OR

(1) The offeror is not the person in their organization responsible within that organization for the decision as to
prices being offered but has been authorized in writing to act as agent for the persons responsible for such
decision in certifying that such persons have not participated, and will not participate, in any action contrary
to subparagraphs A(1) through A.(3) of this section, and as their agent does hereby so certify; and
(2) The offeror has not participated, and will not participate, in any action contrary to subparagraphs
through A(3) of Announcement RSCS1.

6.

Offeror acknowledges
date.

receipt of amendments to invitation

(if applicable)

by entering the amendment

MENDMENT

NO.

DATE

AMENDMENT

NO.

DATE

IAMENDMENT

NO.

DATE

AMENDMENT

NO.

DATE

The certifications,

warranties, andIZIP
representations
as NO.
set forth in this invitation
are day
hereby
,20
of made.
ITITLE
CODE
ITELEPHONE
I FAXNO.
I STATE
ITELEPHONE
NO.

IN WITNESS WHEREOF, the undersigned has executed this offer this
CITY
SIGNATURE
ADDRESS
TYPE
OF FIRM (Corporation, Partnership, or Sole Proprietorship)

A(1)

number and

- -;:3- --,,.-- •••• DECREASE
- ••...
_-, - ------. ----, -.-- .- •....- .•..- ...... -----.. ----- ... - ..• -- COMPANY LOCATION
PRICE
Commodity
Type
VENDOR
NAME
DATE NO.
LOCATION/ITEM
PAGE
NUMBER
INVITATION
NO.
eee USE ONLY - Bidder No.
VENDOR'S
USE
iANNOUNCEMENT
ONLY
KANSAS
NDM
$0.10
Please
type.
KC-327
-RSCS
RSCS1
Fax:
816-926-6381
Attn:
DAIRY
BID
BOX
OFFER
REPLACEMENT
AND
THE
PRICES
PRICE
MODIFICATION
ARE
NOT
ACCEPTABLE
BEING
CONSIDERED
AND
WILL
RESULT
NONRESPONSIVE.
IN
BOTH
THE
ORIGINAL
Kansas
City,
MO
set
in this must
invitation
are an
hereby
made.
Priceforth
changes
indicate
increase
or decrease
of the original price offered.
MARKET
PRICE ADJUSTMENTS
---

3

LINE

SIGNATURE

2
453

KC-327 -RSCS

VENDOR

NAME
PAGENO.fA.NNOUNCEMENT
INVITATION

4

NO.

RSCS1

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 information is 7CFR, Chapter 14. The information will be used to
evaluate bids to sell processed commodities.
Furnishing the requested information is voluntary.
Failure to furnish the
requested information will result in non-consideration.
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 use 714m;
and 31 use 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
information without prior OMB approval mandated by the Paperwork Reduction Act of 1995. The time required
this information collection is estimated to average 30 minutes per response, including the time for reviewing
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
information.

NONDISCRIMINATION

collection of
to complete
instructions,
collection of

STATEMENT

. The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities and activities on the
basis or 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, 1400
Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TOO). USDA is an equal
opportunity provider and employer.