FreightForwardercertificationforms

OMB Control No. 0551-0035

USDA is an Equal Opportunity Employer

Food for Progress

Freight Forwarder Certification

[Insert Participant Name] has selected [insert Freight Forwarder Name] to act as freight forwarder for all [insert Participant Name] FY 20XX Food for Progress Program agreements.

OR

[Insert Participant Name] has selected [insert Freight Forwarder Name] to act as freight forwarder for all [insert Participant Name] FY 20XX Food for Progress Program agreements in [insert Country Name].

[Insert Participant Name] certifies that [insert Freight Forwarder Name] is licensed by the Federal Maritime Commission and:

1) is not engaged, and will not engage, in supplying commodities or furnishing ocean transportation or ocean transportation-related services for commodities provided under any Food for Progress Program agreement to which the [insert Participant Name] is a party; and

2) is not affiliated with [insert Participant Name] and has not made arrangements to give or receive any payment, kickback, or illegal benefit in connection with its selection as an agent of [insert Participant Name].

Name and Title of Participant Representative

Signature of Participant Representative

The public reporting burden for this information collection is estimated to be 10 minutes. This burden estimate includes time for reviewing instructions, researching existing data sources, gathering and maintaining the needed data, and completing and submitting the information. Send comments regarding the accuracy of this burden estimate and any suggestions for reducing the burden to: U.S. Department of Agriculture, Foreign Agricultural Service, Office of Capacity Building and Development, Food Assistance Division, Attn: OMB Number (0551-0035), 1400 Independence Avenue., S.W., Washington, DC 20250-1034. You are not required to respond to this collection of information unless a valid OMB control number is displayed.

McGovern-Dole International Food for Education and Child Nutrition Program

Freight Forwarder Certification

[Insert Participant Name] has selected [insert Freight Forwarder Name] to act as freight forwarder for all [insert Participant Name] FY 20XX McGovern-Dole International Food for Education and Child Nutrition Program (McGovern-Dole) agreements.

OR

[Insert Participant Name] has selected [insert Freight Forwarder Name] to act as freight forwarder for all [insert Participant Name] FY 20XX McGovern-Dole International Food for Education and Child Nutrition Program (McGovern-Dole agreements in [insert Country Name].

[Insert Participant Name] certifies that [insert Freight Forwarder Name] is licensed by the Federal Maritime Commission and:

1) is not engaged, and will not engage, in supplying commodities or furnishing ocean transportation or ocean transportation-related services for commodities provided under any McGovern-Dole Program agreement to which the [insert Participant Name] is a party; and

2) is not affiliated with [insert Participant Name] and has not made arrangements to give agent of [insert Participant Name].

Name and Title of Participant Representative

Signature of Participant Representative

The public reporting burden for this information collection is estimated to be 10 minutes. This burden estimate includes time for reviewing instructions, researching existing data sources, gathering and maintaining the needed data, and completing and submitting the information. Send comments regarding the accuracy of this burden estimate and any suggestions for reducing the burden to: U.S. Department of Agriculture, Foreign Agricultural Service, Office of Capacity Building and Development, Food Assistance Division, Attn: OMB Number (0551-0035), 1400 Independence Avenue., S.W., Washington, DC 20250-1034. You are not required to respond to this collection of information unless a valid OMB control number is displayed.