FV-74 924-CA Desert Grape Confidential Questionnaire

OMB No. 0581-0189

UNITED STATES DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE FRUIT AND VEGETABLE PROGRAMS CONFIDENTIAL QUESTIONNAIRE			Please check applicable box
			Public Member
			Handler
			Grower
The following information is for use by the Secretary of Agriculture (the “Secretary”) in selecting members or alternate members for appointment to the California Desert Grape Administrative Committee to administer Marketing Order No. 925, regulating the handling of grapes grown in southeastern California.
NAME
MAILING ADDRESS (Incl. City, State, and Zip Code)		TELEPHONE NO. (Incl. area code)
		FAX NO. (Incl. area code)
E-MAIL ADDRESS
NUMBER OF YEARS IN TABLE GRAPE BUSINESS (if not applicable, do not respond)
(a) DURING THE CURRENT CROP YEAR I PRODUCED ____________ LUGS OF GRAPES GROWN ON _____________ ACRES, WHICH I OWN OR LEASE. (if not applicable, do not respond)
(b) WHAT IS THE NAME OF THE GRAPE MARKETING FIRM WITH WHOM YOU ARE AFFILIATED? (to be completed by handler only)
MY GRAPES ARE LOCATED IN THESE COUNTY(IES) (to be completed by producer only)
WHAT IS THE NAME OF THE SHIPPER WHO HANDLES YOUR GRAPES? (to be completed by producer only)
ARE YOU AFFILIATED WITH A GRAPE HANDLER (PACKER) AS AN EMPLOYEE, OFFICER, DIRECTOR, OR IN ANY OTHER CAPACITY? (to be completed by public member only) □ YES □ NO If Yes, what is your affiliation?
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 U.S. 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. The 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. The USDA is committed to a comprehensive legal defense policy for all Committee members and employees acting within the scope of their authorized Committee duties and responsibilities.

CERTIFICATION STATEMENT: I hereby certify that I will serve on the California Desert Grape Administrative Committee if appointed by the Secretary of Agriculture

______________________________________________________ __________________________

Signature Date

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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 TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 or (202) 720-6832 (TDD). USDA is an equal opportunity provider and employer.

FV-74 (Rev. 07/10. Destroy previous editions.)