FV-651 Agreement for Participation in Audit Verification Progra

FORM APPROVED BY OMB No. 0581-0125

	UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE, FRUIT AND VEGETABLE PROGRAM AGREEMENT FOR PARTICIPATION IN AUDIT VERIFICATION PROGRAMS Good Agricultural Practices & Good Handling Practices Audit Program (GAP&GHP) Identity Preservation Program (IP) Partners in Quality Audit Program (PIQ)
Company Information
I a duly authorized representative of (Insert Name) (Name of Company) (Street Address, City, State, and Zip Code) hereinafter referred to as the applicant, do hereby agree to be audited under a voluntary USDA, AMS, Specialty Crops Inspection Division audit program. The audit shall include verification of the company’s farm(s), packing facilities, storage facilities, wholesale distribution centers or other locations as applicable to the audit scope(s).
The applicant agrees that with respect to:
Laws, Regulation, Statutes - To conform with all applicable Federal, State, and local government laws, regulations, or statutes, including, but not limited to: Regulations Governing Inspection and Certification of Fruits and Vegetables and Related Products (7 CFR, Part 51), any other pertinent regulations, and any such instructions covering inspection and certification of the products and verification of the processes as may be issued by AMS. Audit Request - To contact and schedule the audit with the appropriate federal or federal-state inspection office (using the FV-237A form). The request for the initial audit will be made no later than two (2) weeks prior to the end of the growing/harvesting/packing season. Records - To maintain all records required by the specific audit program including, but not limited to, quality manual, food safety manual, water test results, employee training records, manure use records, laboratory testing results and other records as required by the quality manual, food safety manual or specific audit program requirements. The applicant shall make these records available to USDA federal and/or federal-state auditors. Access to Facilities - To grant permission for AMS authorized personnel to enter any and all farms and/or facilities covered by the specific audit program for the purposes of conducting the audit. This includes the initial audit and any unannounced audits as may be required by the program. Payment - To pay by credit card, check, draft, or money order drawn to the order of the appropriate federal or federal-state agency for the services covered herein on or before the due date specified on the billing statement. Charges for GAP&GHP audits include, but are not limited to, the audit fee as listed in the fee schedule or Federal Register and travel expenses for the initial audit and any unannounced audits as may be required by the program. Failure to pay for services will result in decertification.
AMS agrees that with respect to:
Perform Audit – To provide objective third-party verification of the applicant’s specific audit program using internationally recognized audit principles. Opening & Exit Interviews - To discuss the audit prior to and report the results and observations with the applicant after each audit and provide a timeframe in which a copy of the completed audit report or checklist will be provided. Reports - To issue to the applicant reports of all audits and evaluations of the applicant’s specific audit program and provide written notification of any deficiencies found, if any. Confidentiality - To consider and treat any trade secrets or confidential information as proprietary and confidential. To consider any records and related information provided to AMS as information that is voluntarily submitted to AMS because of their participation in the specific audit program. Issuance of Certificate, Posting and Sharing Audit Results - To issue a certificate to the applicant and to post audit results to the USDA website, only when the applicant meets the USDA acceptance criteria for each scope being audited. NOTE: If an applicant does not want their company to be posted on the USDA website they must put their request in writing. To provide the specific applicant checklist and results of individual questions to other parties or web-based systems only at the written request of the applicant (See the Optional section on page 2 of this form). NOTE: Reports containing a compilation of audit information can be shared with the Food and Drug Administration. In addition, AMS will notify FDA in the event of an imminent food safety risk.

FV-651 (04-14) Page 1 of 2

FORM APPROVED BY OMB No. 0581-0125

3. It is mutually agreed that with respect to:

1. Length of Service - That the audit results for GAP&GHP audits are valid for one year from the date of the initial audit, provided that the USDA acceptance criteria is met on both the initial audit and any unannounced audits that may be required by the program. For all other audit programs, the length of service is outlined in the specific audit program policy guide. This agreement shall remain in effect for the length of time the auditee remains a participant in the specific audit program.

2. Maintaining Certification - That a company’s information will only remain on the USDA website if any and all unannounced audits show satisfactory adherence to the program. If the USDA acceptance criteria is not met, the company’s information will be removed from the website until a follow-up audit is conducted by AMS verifying that effective corrective actions have been taken and the company meets the USDA acceptance criteria on all appropriate scopes of the audit.

Approved By:

Name of Applicant (Print): Title:

Signature: Date:

USDA Agricultural Marketing Service, Fruit & Vegetable Program/ Federal or Federal-State Inspection Program Supervisor

Name of Representative (Print): Title:

Signature: Date:

(OPTIONAL) The applicant request AMS to release audit results to:

1. Web-based Systems- The auditee designates the audit report is loaded into the following database (check all that apply):

___ icix ___ Azzule Systems ___ FoodLogiQ

2. Other Parties- The auditee designates the specific applicant checklist and results of individual questions be sent to:

___________________________________ _____________________________ ___________________ (Name of Company/Representative) (Email Address) (Phone)

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 valid OMB control number. The valid OMB control number for this information collection is 0581-0125. The time required to complete this information collection is estimated average 8.5 hours 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.

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, S.W., Washington, D.C. 20250-9410, or call (800)795-3272 (voice) or (202)720-6382 (TDD). USDA is an equal opportunity provider and employer.

FV-651 (04-14) (Previous editions are to be destroyed) Page 2 of 2