CCC0331D_(Sugar)_7_19_13_(amend__opt_).pdf

This form is available electronically. Continuation Sheet on Page 2 CCC-331D (Sugar) U.S. DEPARTMENT OF AGRICULTURE (08-12-13) Farm Service Agency

OFFER FORM TO PURCHASE SUGAR FROM THE

COMMODITY CREDIT CORPORATION

1. ANNOUNCEMENT: _____

INVITATION NO.

IF AMENDED, AMENDMENT NO.

In accordance with Announcement _____, Invitation No. , Dated , the undersigned offers to purchase the following quantities of Bulk Sugar from the Commodity Credit Corporation (CCC).

2A. FIRM NAME/EPA PLANT NO. (If applicable)

2B. ADDRESS

2C. CONTACT NAME

2D. TELEPHONE NO. (Include Area Code)

2E. FAX NO. (Include Area Code)

2F. EMAIL ADDRESS

3A.

CATALOG ITEM NO.

3B.

STORAGE LOCATION

City, State

3C.

PRICE OFFERED

(price per pound, maximum decimal places, as specified in invitation)

3D.

INSTORE BID

QUANTITY

(pounds)

4. MISCELLANEOUS INFORMATION

5A. SIGNATURE OF OFFICER/EMPLOYEE

RESPONSIBLE FOR THE OFFER

5B. NAME OF OFFICER/EMPLOYEE RESPONSIBLE

FOR THE OFFER

5C. DATE SIGNED

(MM-DD-YYYY)

NOTE: 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 1402, 7 CFR Part 1435, and the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.). The information will be used to evaluate offers submitted by an offeror to purchase bulk sugar from CCC. 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 a determination that the offer to purchase bulk sugar from CCC cannot be accepted/processed.

The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO THE USDA-FSA-DACO-KCCO, Beacon Facility - MAILSTOP 8698, P.O. BOX 419205, KANSAS CITY, MO 64141-6205.

As specified in the Paperwork Reduction Act (5 CFR 1320.3), the information collection for the Sugar Program, including the Feedstock Flexibility Program, does not require OMB approval, because FSA estimates that fewer than 10 participants will participate by purchasing bulk sugar owned by CCC.

The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or e-mail at program.intake@usda.gov.

Individuals who are deaf, hard of hearing, or have speech disabilities and wish to file either an EEO or program complaint, please contact USDA through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (in Spanish). Persons with disabilities, who wish to file a program complaint, please see information above on how to contact us by mail directly or by email. If you require alternative means of communication for program information (e.g., Braille, large print, audiotape, etc.) please contact USDA’s TARGET Center at

(202) 720-2600 (voice and TDD).

http://www.ascr.usda.gov/complaint_filing_cust.html mailto:program.intake@usda.gov

CCC-331D (Sugar) (08-12-13) Page 2 of 2

OFFER FORM TO PURCHASE SUGAR FROM THE

COMMODITY CREDIT CORPORATION

(CONTINUATION SHEET)

1. ANNOUNCEMENT: _____

INVITATION NO.

IF AMENDED, AMENDMENT NO.

3A.

CATALOG ITEM NO.

3B.

STORAGE LOCATION

City, State

3C.

PRICE OFFERED

(price per pound, maximum five decimal places)

3D.

INSTORE BID

QUANTITY

(pounds)

Instructions For CCC-331D

OFFER FORM TO PURCHASE SUGAR FROM THE COMMODITY CREDIT

CORPORATION

This form is used by participants offering to buy Commodity Credit Corporation (CCC)-owned sugar, and the information gathered is used to evaluate bids offered to CCC for the sale of CCC-owned sugar.

Submit the original of this completed form to the USDA-FSA-DACO-KCCO, Beacon Facility – Mailstop 8698, P.O. Box 419205, Kansas City, MO 64141-6205.

Participants offering to buy CCC-owned sugar must complete Items 1 through 5C of this form.

Items 1-5C

Fld Name / Item No.

Instructions

Announcement and Invitation No.

Please enter Announcement and Invitation No. Acknowledge any amendment(s) by entering the Amendment No. In the block directly below, re-enter Invitation No. and date of Invitation.

2A Firm Name/EPA Plant No.

Enter offering firm’s name. Enter EPA Plant No. (if applicable) for any domestic firm offering under the Feedstock Flexibility Program (FFP).

2B Address

Enter address of offering firm.

2C Contact Name

Enter appropriate contact name.

2D Telephone No.

Enter telephone no. of offering firm (including area code).

2E FAX No.

Enter fax no. of offering firm (including area code).

2F Email Address

Enter email address of offering firm.

3A Catalog Item No.

Enter Catalog Item No. or Nos. from the catalog listing of CCC-owned sugar that you are interested in purchasing.

3B Storage Location

Enter the storage location shown in the Catalog Listing of sugar (City/State).

3C Price Offered

Enter the price per pound that you are offering for CCC-owned sugar.

3D In-store Bid Quantity

Enter the quantity in pounds of in-store sugar shown in the Catalog Listing that you are interested in buying.

4 Miscellaneous Enter additional information applicable as specified in the Invitation.

CCC-331D (Sugar) Instructions, Page 1 of 2 As of: 08-12-13

Fld Name / Item No.

Instructions

5A Signature of Officer/ Employee Responsible for the Offer

If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office.

5B Name of Officer/ Employee Responsible for the Offer

Enter the printed name of the Officer/Employee responsible for the offer.

5C Date Signed

Enter the date (MM-DD-YYYY) that Offer Form is signed.

CCC-331D (Sugar) Instructions, Page 2 of 2 As of: 08-12-13