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See reverse side for Privacy Act, Public Burden and Nondiscrimination Statements Jeffries;Elisa - FSA;Kansas City;MO 11.0.1.20130830.1.901444 See reverse side for Privacy Act, Public Burden and Nondiscrimination Statements.

Form Approved - OMB No. 0560-0177

KC-337

U.S. DEPARTMENT OF AGRICULTURE

(02-16-16) Farm Service Agency Rate Schedule Country/Region:

Base Year and/or any Option Years:

DISCHARGE SURVEYS

Metric Tons (MT) Rates are per net MT except for Min. Fee Type of Cargo Up to 999 MT Min. Fee*

1,000 - 5,000 MT

5,001 - 10,000 MT

10,001 MT and above Bulk-No bagging Bulk-Including Bagging Breakbulk

DRAFT SURVEYS

Rate for each draft survey:

(Cost is separate from your base rates.)

CUSTOMS LOCATIONS

Rate per workday:

(Cost shall be expressed per workday.)

THROUGH BILL OF LADING SURVEYS

(Rates must include cost to perform surveys at both the discharge and delivery locations.)

Metric Tons (MT) Rates are per net MT except for Min. Fee Type of Cargo Up to 999 MT Min. Fee*

1,000 - 5,000 MT

5,001 - 10,000 MT

10,001 MT and above Bulk-No bagging Bulk-Including Bagging Breakbulk

CONTAINERIZED SHIPMENT SURVEYS

(Rates for shipments delivered inland must cover surveys conducted at both the discharge and delivery locations.)

Number of Containers (Rates are per net MT except for Min. Fee) Min. Fee* Min. 10 / Max. 25 Min. 26 / Max. 50 51 and above No Devanning (1) Devan at Port (2) Devan at Inland Delivery Location (3) Devan at Port + Breakbulk Inland Delivery Location (4) Containers are not devanned OR surveyor not a witness to devanning. Container and seal check only. Attendance at port.

Containers are devanned at port (within 25 km. radius). Attendance at port.

Containers are transported inland where devanning occurs. Attendance at port and inland delivery location.

Containers are devanned at port, cargo loaded onto conveyance to inland destination for breakbulk survey. Attendance at port and inland delivery location.

Minimum fee applies only shipments of less than 1,000 MT or shipments of less than 10 containers.

Rate schedule must be stated in U.S. currency ($0.00) I certify that this firm has the expertise necessary to perform the survey services required by Commodity Credit Corporation in this country/region. I further certify that this rate schedule is my bid to perform survey services in this country/region for a period of one year from the date the contract is awarded to this firm and that such rate schedule is all-inclusive and will not change during the period under which the contract is effective.

SIGNATURE

TITLE

DATE

FIRM NAME

EMAIL

KC-337 (PAGE 2)

(02-16-16)

PRIVACY ACT AND PUBLIC BURDEN STATEMENTS

The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a – as amended). The authority for requesting the information identified on this form is 7 CFR Part 1400, the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.), and the Agricultural Act of 2014 (Pub. L. 113-79). The information will be used by potential CCC-contracted surveyors to bid on performing cargo survey services. The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-3, Consultants File. Providing the requested information is voluntary. However, failure to furnish the requested information will result in non-consideration of the bid to perform the cargo survey services required by CCC.

Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to average 30 minutes 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Agriculture, Clearance Officer, OIRM (OMB No. 0560-0177), Stop 7630, Washington, D.C. 20250-7630.

NONDISCRIMINATION STATEMENT

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

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 Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide 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: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690- 7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.