Form PDS-6100 Live Poultry Dealer Disclosure Document

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FAIR TRADE PRACTICES PROGRAM
PACKERS AND STOCKYARDS DIVISION

LIVE POULTRY DEALER
DISCLOSURE DOCUMENT

This form will be provided to Live Poultry Dealers to provide the necessary disclosures and
documentation to poultry growers in accordance with Section 410(a) of the Packers and
Stockyards Act, 1921, as amended and supplemented (7 U.S.C. 228b-1).

1.
2.
3.

Company
Name:
Business Type:

4.

Business
Address:
Contact Name

5.

Telephone No.:

6.

Email Address:

7.

Website
Address

8. Grower Name: ___________________________________________________
9. Term of Contract:

(a) From (date): ________________________
(b) To (date) : _________________________

10. DISCLOSURE 1:
The income from your poultry farm may be significantly affected by the number of
flocks placed on your farm each year, the density or number of birds placed with
each flock, and the target weight at which poultry is caught. The poultry company
may have full discretion and control over these and other factors. Please carefully
review the information disclosed in this document.
11. Under the terms of this poultry growing arrangement:
a. Minimum number of flocks placed on your farm each year: __________
b. Minimum stocking density of flocks placed on your farm: __________
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12. DISCLOSURE 2:
(Company to check the applicable statement below)
______ a. This disclosure document summarizes certain provisions of your
poultry growing arrangement and other information. You have the right to read
this disclosure document and all accompanying agreements carefully. The live
poultry dealer is required to provide this disclosure agreement to you with a copy
of the poultry growing arrangement that does not contain new or modified housing
specifications that would require you to make an original or additional capital
investment at least seven calendar days before the live poultry dealer executes the
poultry growing arrangement.
OR
______ b. This disclosure document summarizes certain provisions of your poultry
growing arrangement and other information. You have the right to read this
disclosure document and all accompanying agreements carefully. The live poultry
dealer is required to provide this disclosure document to you simultaneously with
(a) a copy of the poultry growing arrangement, (b) new or modified housing
specifications that would require you to make an original or additional capital
investment, and (c) a letter of intent.
13. DISCLOSURE 3:
The terms of your poultry growing arrangement will govern your
relationship with the company. Notwithstanding any confidentiality provision in
the poultry growing arrangement, you have the right to discuss the terms of the
poultry growing arrangement and the Live Poultry Dealer Disclosure Document
with a Federal or State agency, your financial advisor or lender, your legal advisor,
your accounting services representative, other growers for the same live poultry
dealers, members of your immediate family and business associates. A business
associate is a person not employed by you, but with whom you have a valid
business reason for consulting when entering into or operating under a poultry
growing arrangement.
Note that USDA has not verified the information contained in the
document. However, if it contacts any false or misleading statement or a material
omission, a violation of federal or state law may have occurred.

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14. CERTIFICATION:
I certify that (a) ____________________________ [company name] has
established, maintains, and enforces a governance framework designed to audit the
accuracy and completeness of this Live Poultry Dealer Disclosure Document and
all attachments and to ensure compliance with all obligations under the Packers
and Stockyards Act, as amended and supplemented and the regulations thereunder.
I further certify that this Live Poultry Dealers Disclosure Document does not
contain any untrue statement of a material fact or omit to state a material fact
necessary in order to make the statements made, in light of the circumstances
under which such statements were made, not misleading.
(b) Company Signature

(c) Date

(d) Printed Name:
(e) Title:

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POULTRY GROWER SIGNATURE PAGE
If the live poultry dealer does not deliver this disclosure document within the time
frame specified in the cover pages of this document, or if this disclosure document
contains any false or misleading statement or a material omission (including any
discrepancy with other oral or written statements made in connection with the poultry
growing arrangement), a violation of federal and state law may have occurred. Violations
of federal and state laws may be determined to be unfair, unjustly discriminatory, or
deceptive and unlawful under the Packers and Stockyards Act, as amended. Allegations
of such violations may be reported to the Packers and Stockyards Division of USDA’s
Agricultural Marketing Service.
.
15.

I acknowledge receipt of this Live Poultry Dealer Disclosure Document.
_________________________________________
15a Grower Signature

_____________________
15b Date

_________________________________________
15c Printed Name

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__________________________________________________________________

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 is 0581-0308 The time required to complete this
information collection is estimated to average .90 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.
In accordance with Federal law and U.S. Department of Agriculture (USDA) civil rights regulations and
policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex,
age, disability, and reprisal or retaliation for prior civil rights activity. (Not all prohibited bases apply to
all programs.) Persons with disabilities who require alternative means of communication for program
information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the
responsible State or local Agency that administers the program or USDA’s TARGET Center at (202) 7202600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.
Additionally, program information is also available in languages other than English.
To file a complaint alleging discrimination, complete the USDA Program Discrimination Complaint
Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA
office or write a letter addressed to USDA and provided in the letter all of the information requested in
the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or
letter to USDA by: (a) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil
Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (b) fax: (202) 690-7442; or (c)
email: [email protected].

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