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Agribusiness Support FundA Company Incorporated under Section 42 of Companies Ordinance 1984
1144-CCA, Block DD, Phase IV, D.H.A, Lahore. Phone: 042-35749081-3, 35899761-2
Fax: 042-35749084 www.asf.org.pk, Email: info@asf.org.pkPAGE 1OF 33
Dated: October 17, 2012
Jawad H. Shirazi
PartnerExon Dairy Farm
House # 20, Street # 6
Lane V, Cavalry Ext.
Lahore, Pakistan
Request for Application (RFA) # 007/12
Exon Dairy
Dear Sir,
This is with reference to Expression of Interest (EOI) submitted by Exon Dairy Farm in response
to Call for EOIs announced by ASF under USAIDs Agribusiness Project (UAP) dated May 20,2012. I am pleased to inform that your project namely Exon Dairyhas been shortlisted for the
next stage of grant cycle and you are hereby invited to submit a full grant application for the
aforementioned project. UAP plans to provide cost sharing grant amounting to PKR equivalent
of up to USD 25,000. The objective of this grant is modernization of existing dairy farm leading to
increased sales, employment generations, increase in household incomes.
Please note that following component(s) of your project will be supported by UAP under its
Grant Program and hence you are requested to kindly submit your grant application keeping
in view the below mentioned components of your project.
Bio Gas Plant
Silage Making Machine
Wanda Machine
IP based CCTV Camera with UPS
Plough & Rotavator
Solar Light with pole
Computer & Recording Software
Component(s) and associated costs other than the above, if any mentioned in your submitted
EOI, should not be included in the grant requestedfrom UAP, but mustappear in total project
budget to enable a complete view of the proposed project.
Please note that this RFA does not constitute a commitment on the part of ASF/UAP to obligate
monies, and that application preparation and submission are assumed by Exon Dairy Farm at its
own risks and costs. Also, ASF/UAP specifically notes that the execution of an award or the
obligation of monies is subject to the availability of funds. Specifically, no award or obligation
will be made until funds have been fully allocated and committed through ASF/UAPs internal
procedures for this specific project/activity.
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Request for Application No. 007/12 PAGE 2OF 33
Final decision on grant award will be made by the competent authority in accordance with
evaluation criteria provided in the attached RFA. . If your project is approved for a grant, UAP
will sign a grant agreement with you. The grant agreement will be negotiated, denominated
and funded in Pakistani Rupees. Payments will be made on a reimbursement basis in tranches
corresponding to achievement of mutually agreed upon milestones orin exceptional cases, on a
periodic advance and liquidation basis and/orin-kind support may be provided. The decision onabove mode of payments/ in-kind support/ type of grant agreement will be made by ASF/UAP
as part of an eventual analysis of your capability to manage grant funds. All costs funded by the
grant must be allowable, allocable and reasonable. A cost-sharing element (in an amount at
least equal to the funds provided by UAP) from you and/or an approved third party must be
contributed to the grant activity. See Annex F for cost share information. The Grant application
must be supported by a detailed and realistic budget as described in Annex B.
Please review the attached RFA and submit your complete application before November 17,
2012.
Please also note that ASF/UAP will not fund any projects or activities that are determined to
cause significant harm to the environment or increase tensions between ethnic or social groups
till proper mitigation measures are devised for such harms/ tensions and agreed between
ASF/UAP and the applicant.
In addition to the above, you must be willing to sign the following required certifications prior
to receiving a grant. UAP will provide the certifications once your proposal is approved for grant
funding.
Certification Regarding Terrorist Financing
Recipient Certificate of Compliance
Please submit your questions via email atmuslim.raza@asf.org.pk.
Sincerely,
________________________
Shad Mohammad
Chief of Party
USAIDs Agribusiness Project
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Request for Application No. 007/12 PAGE 3OF 33
Annexes:
Annex A: Grant application form
Annex B: Budget forms
Annex C: Grant application preparation and submission guidelines
Annex D: Evaluation Criteria
Annex E: Certifications, Assurances, and Other Statements of ApplicantsAnnex F: Other Provisions/ Conditions
Annex G: Documents required with grant application; and
Annex H: Cost Share Guidelines/ Ineligible expenses
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Request for Application No. 007/12 PAGE 4OF 33
Annex A: Grant application Form
[The UAP Team is available to answer any questions you may have and to assist you in
completing this grant application, if necessary.]
This application is in response to RFA No. 007/12titled Exon Dairy.
Section I (Basic Information)
1. Name of Applicant:
2. Legal status: (individual, partnership concern, limited company, association, sole
proprietor):
3. Date of Registration (required for all applicants other than individuals) :
4. Contact information:
Name of key contact person(s) and title:
Office address: Office phone:
Mobile: Fax:
E-mail: Website:
List the full names and titles of legal representative(s), owner(s), chief executive(s) and
key staff (president, directors, treasurer, etc), as applicable.
Name Title
5. Describe your organization and its purpose:
Abbas Sajjad (Partner), Jawad H. Shirazi(Partner),Nadeem Ahmad Gillani (CEO)
House # 2o, Street # 6, Lane V, Cavalry Ext. Lahore. 042-36675631
0300-8446659; 0300-8211676
abbas203@hotmail.com; jawadshirazi@gmail.com
Nadeem Ahmad Gillani CEO
Exon Dairy
Partnership
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Request for Application No. 007/12 PAGE 5OF 33
Section II (Project Description).
6. Title of proposed activity:
7. Objective of proposed activity:
8. Background: What is the issue or problem that your activity will address? Why is it critical to
address this issue?
9. Describe your activity in detail (or attach a project description):
10.Please list the results to be achieved and the indicators you will use to measure success. In
addition to quantitative indicators, you may also suggest others ways to measure success or
impact.
11.Describe your method for selecting participants and beneficiaries. Mainly how you expect to
target women, by increasing employment opportunities and entrepreneurship.
12.Anticipated duration of proposed activity:
Overall length (total number of months)
Start and end date (day, month, and year)
EXON Dairy is located in District Sahiwal just around 10 kilometers away from the main city. The project started in2009 and its current herd size comprises of 100 cross breed animals all locally procured with 50% productive heads.From the inception it sells all the milk produced to the Nestle Pakistan Ltd. The project has gone through a learningcurve of three eventful years of dairy farming experience and the first breed of heifers is now calving on the farm.
Exon Dairy
and to create awareness and promote standard practices of dairy farming through a profitable commercial venture, and thus contribute the national economy. 3.To run Exon Dairy as a model hi-tech dairy farm to promote dairy farming among the farmers of adjoining area and to create awareness of use of latest dairymanagement practices such as mechanized milking, Silage Fodders, artificial inseminations techniques, computerized record maintenance, Bio Gas, Solar energypurpose built housing for cow comfort etc.
Efficiency improvement & Cost reduction by adding proposed machinery and equipment. Detailsattached
Installation of farm machinery for efficiency improvement, computerized data recording. Development ofBio Gas Plant for energy cost reduction and assurance of smooth supply of electricity.
1. Per unit cost reduction; 2. Milk Production improvement (liters per cow) 3.ROA & ROIImprovement
1. Farmers in the vicinity will be benefitted by buying Wanda from the Exon set up of commercial production of Wanda. 2. In Future the training centre will be set upfrom which the local farmers will benefit out of the trainings. 3. The Bio gas sourced tube well will be able to irrigate surrounding farmers lands. 4. The workershouseholds adjacent to the farm will benefit from the bio gas for their cooking needs. 5. The silage making machine will be rented to the surrounding dairy farmers.6.Women belonging to the worker families will have equal opportunity to join the expanded operations of the farm.
3 months
January 1 - March 31,2013
1. To strengthen the capacity of smallholders by sharing best practices and providing assistance tosmallholders operate autonomously and efficiently. 2. To create employment in the farming sector
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Request for Application No. 007/12 PAGE 6OF 33
Section III (Project Implementation Plan)
13.Implementation plan: Main tasks, with estimated start and end dates for each task. Please
include all events, trainings, publications, etc.
Description of Main Tasks Name(s) of staff
responsible
Start Date End Date
Task 1:
Task 2:
Task 3:
Task 4:
Task 5:
Task 6:
Task 7, etc: (please add rows as needed)
14.Location(s) of the activity (add more rows as needed).
# Union Council Tehsil District Province
1
Section IV (Experience and Capacity)
15.List personnel who will be involved in implementing this project (CVs are required of all key
project personnel):
16.If available, please attach an organization chart, organizational profile, audited financial
statements, annual reports or any other relevant documentation.
Development of Bio Gas Plant
Procurement of Silage Making Machine, WandaMachineIP based CCTV Camera with UPS Plough& Rotavator
Installation of Solar Light with pole & Energyefficient tubewell pump
Implementation of Computer & Recording Software
Nadeem Ahmad Gillani
Nadeem Ahmad Gillani
Nadeem Ahmad Gillani
Nadeem Ahmad Gillani
Jan 1, 2013
Jan 1, 2013
Jan 1, 2013
Jan 1, 2013
March 31, 2013
March 31, 2013
March 31, 2013
March 31, 2013
Sahiwal Sahiwal Sahiwal Punjab
Abbas Sajjad; Jawad H. Shirazi; Nadeem Ahmad Gillani (CVs provided in EOI attached,
refer Section No. 3(e)
(Attached)
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Request for Application No. 007/12 PAGE 7OF 33
17.Mention and provide relevant documentation of any similar or any other relevant projects.
(Project Location, Nature, Value and Present Status)
18.Three references including complete contact information (existing or previous clients,
donors or vendors)
Section V (Cost)
19.Estimated cost in Pakistani Rupees per the attached budget:
Amount requested from UAP: PKR_________________
In-kind and/or other contribution from your organization: PKR _________________
Other donor(s) or third-party resources: PKR _________________
Total Estimated Cost PKR _________________
By affixing my signature below, I certify that to the best of my knowledge, the information
provided in this application is accurate and correct:
Submitted by (name and title): _________________________________________
Signature: __________________________Date: __________________________
N/A
Nestle Pakistan Limited
2,520,000/-
119,013,515/-
0/-
121,533,515/-
Abbas Sajjad (Partner)
November 16, 2012
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Request for Application No. 007/12 PAGE 8OF 33
Annex B: BUDGET FORMS
2.1 Purpose
These forms, when properly completed, reviewed, and approved, serve as the mutually agreed-
upon roadmap for activity financial management. All activity costs must be identified. Costdata must be accurate; proposed amounts should not be unrealistically high or low. To be
successful, a grant activity must be adequately fundednot over-funded or under-funded.
2.2. Instructions
Budget Form
Salaries & WagesSalary or any other forms of direct payment of grant funds to anyApplicant employee (or consultant) who is directly engaged with the grant activityimplementation plan.
Operational Expenses - Other Direct Costs, this covers non-personnel-related costsallocated to implementation of the grant activity (e.g. supplies, Applicant office rent,utilities, etc.).
Consultation CostConsultation charges and other related costs.
Activity Service DeliveryExamples would be the rental of a training facility, or printingof training documents.
TransportationTransportation costs of activity equipment & consumables
Equipment & Consumables - Equipments & consumables purchased specifically for theproposed grant activity; must adhere to USAID local procurement regulations.
Contingencies: Other unforeseen costs necessary for successful completion of theproject , for example, rental of a training facility, or printing of training documents forenhancing staff efficiency/ develop capacity..
Monthly Budget Breakout Form
The monthly budget breakout form contains the same budget information broken out in the
anticipated monthly expenditures. This form helps in projecting cash flow needs.
All proposed grant activity costs must be within the normal operating practices of the Applicant
and in accordance with its (preferably written) policies and procedures.
All line items must be supported by budget notes with enough detail to permit a determination
that the cost is allowable, allocable and reasonable. The budget notes must provide the
reference specifications of items (model, make, capacity etc.) to be purchased under the grant.
Budgeted amounts must also be supported by documented evidence, and the Applicant must
be able to provide such backup to UAP if requested.
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Request for Application No. 007/12 PAGE 9OF 33
BUDGET FORM
Applicant Name: ________________________________________________
Activity Title: ___________________________________________________
Budget Template
Activity Unit CostUnit
No.
Total
Estimated
Cost
Funds
requested from
UAP
Applicant
Cost Share
Salaries & Wages
Personnel
directly
engaged with
the grant
activity
implementation
plan.
Operational Expenses
Project relatedsupplies
Non-personnel
related costs
allocated to
implementation
of grant activity
Office Rent
Utilities
Fuel
Communication
Travelling Cost
Etc.
Office Equipment
& Supplies
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Request for Application No. 007/12 PAGE 10OF 33
Consultation Cost
Consultant 1
Consultant 2
Transportation Cost
Machinery
transportation Transportation
costs of activity
equipment &
consumables
Material
transportation cost
Etc.
Equipment & Consumables
Equipments &
consumables
purchased
specifically for
the proposedgrant activity
Contingencies (if
any)
Total
Note:
- Budget notes are required for each line item in sufficient detail to facilitate a complete cost
allowability determination.
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Request for Application No. 007/12 PAGE 11OF 33
[Provide monthly break-up (for each year) on format provided below.]
Monthly Budget Breakout Form
Applicant Name:_______________________________________________
Activity Title:____________________________________________________
Cash Flow Template
Description
Year 1
1st Quarter
2nd
Quarter
3rd
Quarter 4th Quarter Total
Balance b/f
Cash Outflows
Investment by Applicant
Salaries & Wages
Operational Expenses
Office Equipment & Supplies
Consultation Cost
Transportation Cost
Equipment & Consumables
Contingencies (if needed)
Cash Inflows
Product Sales
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Request for Application No. 007/12 PAGE 12OF 33
UAP Grant
Balance c/f
Product Total
Sales (kg)
Rate
Sales Value (Rs)
Note:
- Each line item mentioned in the cash flow has to be in line with the items mentioned in budget.
- Incase of multiple products, kindly provide separate sales figures.
- Cash flows have to be provided as per project duration.
I certify that to the best of my knowledge and belief the above cost and sales data is accurate,
complete, current, and allowable:
Applicant Signature __________________________________
Date ______________________________________________November 16, 2012
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Annex C: Grant Application preparation and submission guidelines
The applicant must submit its grant application as per the format given in annex A
The application must be received at ASF office in hard copy along with all required
documents by the closing date and time indicated in the cover letter of this RFA. The name
and address of the applicant and the RFA number must be mentioned on the envelope andsent to:
Agribusiness Support Fund
144 CCA, Sector DD
Phase IV, DHA
Lahore
Phone: 042-35749081-3, 35899761-2
The applicant should also submit an electronic softcopy of the application via email with the
name and address of the applicant and the RFA number in subject line to
muslim.raza@asf.org.pk (Syed Muslim Raza, Manager Grants and Contracts, Tel: 042-
35899762, 042-35749081-2).
The receipt of the application will be confirmed within three days.
The total size of each e-mail attachment should not exceed 3 MBs. Every page of the
application must be numbered. The application must have a table of contents. Large graphics
files are discouraged. Attached file format must be Microsoft (2007 - 2010 version) Word,
Excel or PDF.
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Annex D: Evaluation criteria:
EVALUATION CRITERIA
All applications will be evaluated using the evaluation criteria provided ahead. Applications
falling short of any of the following mandatory requirements will be rejected without being
considered for further evaluation.
--------------------------------------------------------------------------------------------
MANDATORY REQUIREMENTS
1. The purpose of the activity (ies) specified in the Application must be consistent with
UAP objectives (e.g., the proposed activity (ies) must contribute to increased sales /
employment generations / increase in household income / and growth in selected
industries/clusters, where possible segregated by Gender).
2. The results to be achieved must be linked to the grant objective as mentioned in the
cover letter.3. The verifiable indicators of achievement must be linked to the grant objectives.
4. The Grantee must contribute to the overall activity (ies) cost in-cash or in-kind.
5. The Grantee must be willing to comply with UAP/USAID environmental policy (in
accordance with 22 CFR 216).
Applications fulfilling the mandatory requirements will be evaluated against the criteria in the
table below:
Evaluation Category Maximum Points
Technical Approach
Innovation / value addition
Feasibility of design
Sustainability/financial self-reliance
10
10
10
Impact on target group
Job Creation
Increase in Income
Gender Awareness
Underserved Area (Project location)
10
10
10
10
Management & Programmatic Capacity
Personnel and team composition
Capability and Past Performance
10
10
Cost Share 10
Total Score 100
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A description of the above categories is as follows:
Technical Approach:
Innovation / value addition:The project focuses on new and innovative ideas / products /
services which can add value to the existing process or system
Feasibility of design. The proposed methodology reflects an understanding of the RFAs
program description and ASF/UAP scope of work. The designed interventions are appropriate
and the deliverable/milestones are concrete and achievable. The implementation plan
includes tasks/activities that are clearly described and organized in a sequential and logical
order; the proposed timelines allow for the maximization of resources and time, and they areclearly assigned to personnel.
Sustainability/financial self-reliance. The extent to which the funded activity will result in
building and strengthening the capacity of the local organizations, and whether the activity
itself is sustainable or will stimulate sustainability of the organization. If cost share is
requested in the RFA, add the following: The proposed cost share elements are relevant to the
objectives of the program and demonstrate the organizations commitment in investing
resources in the program. The application includes a logical and feasible proposal how the
cost share commitments will be met. If applicable, the strategy for collecting counterpart
contributions is feasible. If program income is expected: The proposal for collecting program
income is efficient and realistic. The plan for use of program income is well thought out and in
accordance with the Mandatory as Applicable Standard Provision No 23.
Impact on target group:
The application clearly demonstrates awareness about gender issues. The proposed approach
and indicators for measuring impact women employment and entrepreneurship are well
thought-out and will bring the expected results to the project. The extent to which the
proposed activity corresponds to the needs of target group(s) and will directly benefit them.
Also, the degree to which it will directly or indirectly stimulate other organizations and
resources to develop or implement activities supporting the objectives of the project. Project
will create some new jobs / will improve the skills of existing employees. Project will increase
the current household income of beneficiaries. Applicants are highly encouraged to come up
with projects that can benefit the underdeveloped areas of Pakistan.
Budget
Reasonableness, allowability and realism.
Cost efficiency
Remarks of Members of the
committee evaluating the
proposal.
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Management and programmatic capacity.
Personnel and Team composition: The proposed staff has the technical, managerial and
personal qualifications to adequately perform the role/tasks they have been assigned. The
assignment of tasks in the implementation plan and the proposed team configuration includes
an appropriate mix of experience and technical capabilities to maximize resources and meet
deadlines.
Capability and Past Performance.There is evidence that the organization has the capability to
undertake and accomplish the proposed activities. Appraisal will be based principally on at
least three reference checks done by the GEC; the background, qualifications, reputation,
appropriateness and skills of its key personnel; and the track record, reputation, and
achievements (including development of self-sufficient, sustainable activities) of the
organization involved.
Budget:
ASF/UAP will not assign a score to the budget because the technical merit of the applications
is more important than the proposed cost of the activity. However, ASF/UAP will not select an
application for award on the basis of a superior technical proposal without considering
cost. The budget will be evaluated on the basis of cost reasonableness, allowability, and
realism. Cost realism will be based on considerations such as the following:
- Are proposed costs realistic for the work to be performed (not to high and not too
low)?
- Do the costs reflect a clear understanding of RFA requirements?
- Are the costs consistent with the various elements of the application meaning thatcosts are linked to activities proposed?
The evaluation will also measure degree to which budgeting is clear and reasonable, reflects
best use of organizational and ASF/UAPs grant resourcesand provides reasonable cost share
consistent with the nature of the proposed activity and the applicants abilityto contribute.
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Annex E: Certifications, Assurances, and Other Statements of Applicants
[To be submitted as part of an Applicants application. To be signed by an authorized agent of
the applicant at the end of this Section]
PART I - CERTIFICATIONS AND ASSURANCES
1. ASSURANCE OF COMPLIANCE WITH LAWS AND REGULATIONS GOVERNING NON-
DISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS
(a) The recipient hereby assures that no person in the United States shall, on the bases set
forth below, be excluded from participation in, be denied the benefits of, or be otherwise
subjected to discrimination under, any program or activity receiving financial assistance from
USAID, and that with respect to the grant for which application is being made, it will comply
with the requirements of:
1. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352, 42 U.S.C. 2000-d), which
prohibits discrimination on the basis of race, color or national origin, in programs and
activities receiving Federal financial assistance;
2. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), which prohibits
discrimination on the basis of handicap in programs and activities receiving Federal financial
assistance;
3. Age Discrimination Act of 1975, as amended (Pub. L. 95-478), which prohibits
discrimination based on age in the delivery of services and benefits supported with Federal
funds;
4. Title IX of the Education Amendments of 1972 (20 U.S.C. 1681, et seq.), which prohibits
discrimination on the basis of sex in education programs and activities receiving Federal
financial assistance (whether or not the programs or activities are offered or sponsored by an
educational institution); and
5. USAID regulations implementing the above nondiscrimination laws, set forth in
Chapter II of Title 22 of the Code of Federal Regulations.
(b) If the recipient is an institution of higher education, the Assurances given herein extend to
admission practices and to all other practices relating to the treatment of students or clients
of the institution, or relating to the opportunity to participate in the provision of services or
other benefits to such individuals, and shall be applicable to the entire institution unless the
recipient establishes to the satisfaction of the USAID Administrator that the institution's
practices in designated parts or programs of the institution will in no way affect its practices in
the program of the institution for which financial assistance is sought, or the beneficiaries of,
or participants in, such programs.
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(c) This assurance is given in consideration of and for the purpose of obtaining any and all
Federal grants, loans, contracts, property, discounts, or other Federal financial assistance
extended after the date hereof to the recipient by the Agency, including installment payments
after such date on account of applications for Federal financial assistance which were
approved before such date. The recipient recognizes and agrees that such Federal financial
assistance will be extended in reliance on the representations and agreements made in this
Assurance, and that the United States shall have the right to seek judicial enforcement of this
Assurance. This Assurance is binding on the recipient, its successors, transferees, and
assignees, and the person or persons whose signatures appear below are authorized to sign
this Assurance on behalf of the recipient.
2. CERTIFICATION REGARDING LOBBYING
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or an employee of
a Member of Congress in connection with the awarding of any Federal contract, the making of
any Federal grant, the making of any Federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment or modification of any
Federal contract, grant, loan, or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member ofCongress in connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying
Activities," in accordance with its instructions.
3. The undersigned shall require that the language of this certification be included in the
award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and
contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when thistransaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by section 1352, title 31, United States Code.
Any person who fails to file the required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
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The undersigned states, to the best of his or her knowledge and belief, that: If any funds have
been paid or will be paid to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this commitment providing for the
United States to insure or guarantee a loan, the undersigned shall complete and submit
Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
Submission of this statement is a prerequisite for making or entering into this transaction
imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required
statement shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
3. PROHIBITION ON ASSISTANCE TO DRUG TRAFFICKERS FOR COVERED COUNTRIES
AND INDIVIDUALS (ADS 206)
USAID reserves the right to terminate this [Agreement/Contract], to demand a refund or take
other appropriate measures if the [Recipient/ Contractor] is found to have been convicted of anarcotics offense or to have been engaged in drug trafficking as defined in 22 CFR Part 140.
The undersigned shall review USAID ADS 206 to determine if any certifications are required
for Key Individuals or Covered Participants.
If there are COVERED PARTICIPANTS: USAID reserves the right to terminate assistance to, or
take or take other appropriate measures with respect to, any participant approved by USAID
who is found to have been convicted of a narcotics offense or to have been engaged in drug
trafficking as defined in 22 CFR Part 140.
Signature __________________________________________Date_______________
Name_____________________________________________
Organization________________________________________
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4. KEY INDIVIDUAL CERTIFICATION NARCOTICS OFFENSES AND DRUG TRAFFICKING
I hereby certify that within the last ten years:
1. I have not been convicted of a violation of, or a conspiracy to violate, any law or
regulation of the United States or any other country concerning narcotic or psychotropic
drugs or other controlled substances.
2. I am not and have not been an illicit trafficker in any such drug or controlled
substance.
3. I am not and have not been a knowing assistor, abettor, conspirator, or colluder with
others in the illicit trafficking in any such drug or substance.
Signature: ____________________________
Date: ____________________________
Name: ____________________________
Title/Position: ____________________________
Organization: ____________________________
Address: ____________________________
Date of Birth: ____________________________
NOTICE:
You are required to sign this Certification under the provisions of 22 CFR Part 140, Prohibition
on Assistance to Drug Traffickers. These regulations were issued by the Department of State
and require that certain key individuals of organizations must sign this Certification.
If you make a false Certification you are subject to U.S. criminal prosecution under 18 U.S.C.
1001.
5. CERTIFICATION REGARDING TERRORIST FINANCING
By signing and submitting this application, the prospective recipient provides the certification
set out below:
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1. The Recipient, to the best of its current knowledge, did not provide, within the
previous ten years, and will take all reasonable steps to ensure that it does not and will not
knowingly provide, material support or resources to any individual or entity that commits,
attempts to commit, advocates, facilitates, or participates in terrorist acts, or has committed,
attempted to commit, facilitated, or participated in terrorist acts, as that term is defined in
paragraph 3.
2. The following steps may enable the Recipient to comply with its obligations under
paragraph 1:
a) Before providing any material support or resources to an individual or entity, the
Recipient will verify that the individual or entity does not (i) appear on the master list of
Specially Designated Nationals and Blocked Persons, which list is maintained by the U.S.
Treasurys Office of Foreign Assets Control (OFAC) and is available online at OFACs website:
http://www.treas.gov/offices/eotffc/ofac/sdn/t11sdn.pdf, or (ii) is not included in any
supplementary information concerning prohibited individuals or entities that may be providedby USAID to the Recipient.
b) Before providing any material support or resources to an individual or entity, the
Recipient also will verify that the individual or entity has not been designated by the United
Nations Security (UNSC) sanctions committee established under UNSC Resolution 1267 (1999)
(the 1267 Committee) *individuals and entities linked to the Taliban, Usama bin Laden, or
the Al Qaida Organization]. To determine whether there has been a published designation of
an individual or entity by the 1267 Committee, the Recipient should refer to the consolidated
list available online at the Committees website:
http://www.un.org/Docs/sc/committees/1267/1267ListEng.htm.
c) Before providing any material support or resources to an individual or entity, the
Recipient will consider all information about that individual or entity of which it is aware and
all public information that is reasonably available to it or of which it should be aware.
d) The Recipient also will implement reasonable monitoring and oversight procedures to
safeguard against assistance being diverted to support terrorist activity.
3. For purposes of this Certification-
a. Material support and resources means currency or monetary instruments or financial
securities, financial services, lodging, training, expert advice or assistance, safehouses, false
documentation or identification, communications equipment, facilities, weapons, lethal
substances, explosives, personnel, transportation, and other physical assets, except medicine
or religious materials.
b. Terrorist act means
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i. An act prohibited pursuant to one of the 12 United Nations Conventions and Protocols
related to terrorism (see UN terrorism conventions Internet site:
http://untreaty.un.org/English/Terrorism.asp); or
ii. An act of premeditated, politically motivated violence perpetrated against
noncombatant targets by subnational groups or clandestine agents; or
iii. Any other act intended to cause death or serious bodily injury to a civilian, or to any
other person not taking an active part in hostilities in a situation of armed conflict, when the
purpose of such act, by its nature or context, is to intimidate a population, or to compel a
government or an international organization to do or to abstain from doing any act.
c. Entity means a partnership, association, corporation, or other organization, group or
subgroup
d. References in this Certification to the provision of material support and resources shall not
be deemed to include the furnishing of USAID funds or USAID-financed commodities to theultimate beneficiaries of USAID assistance, such as recipients of food, medical care, micro-
enterprise loans, shelter, etc., unless the Recipient has reason to believe that one or more of
these beneficiaries commits, attempts to commit, advocates, facilitates, or participates in
terrorist acts, or has committed, attempted to commit, facilitated or participated in terrorist
acts.
e. The Recipients obligations under paragraph 1 are not applicable to the procurement of
goods and/or services by the Recipient that are acquired in the ordinary course of business
through contract or purchase, e.g., utilities, rents, office supplies, gasoline, etc., unless the
Recipient has reason to believe that a vendor or supplier of such goods and services commits,
attempts to commit, advocates, facilitates, or participates in terrorist acts, or has committed,
attempted to commit, facilitated or participated in terrorist acts.
This Certification is an express term and condition of any agreement issued as a result of this
application, and any violation of it shall be grounds for unilateral termination of the
agreement by USAID prior to the end of its term.
Signed: ___________________________________
Name and Title: ____________________________
Name of Organization: _______________________
Date: _____________________________________
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6. SURVEY ON ENSURING EQUAL OPPORTUNITY FOR APPLICANTS
http://www.usaid.gov/forms/surveyeo.doc contains a survey on ensuring equal opportunity
for applicants. The applicants completion of the survey is voluntary. The absence of a
completed survey in an application may not be a basis upon which the application is
determined incomplete or non-responsive. Applicants who volunteer to complete and submit
the survey under a competitive or non-competitive action are instructed within the text of the
survey to submit it as part of the application process; applicants who chose to submit the
survey shall include it in the technical application in the annexes section.
PART II - OTHER STATEMENTS OF RECIPIENT
1. AUTHORIZED INDIVIDUALS
The recipient represents that the following persons are authorized to negotiate on its behalf
with the USAIDs Agribusiness Project and to bind the recipient in connection with this
application or grant:
Name Title Telephone No Facsimile No Email Address
2. TAXPAYER IDENTIFICATION NUMBER (TIN)
If the recipient is a U.S. organization, or a foreign organization which has income effectively
connected with the conduct of activities in the U.S. or has an office or a place of business or a
fiscal paying agent in the U.S., please indicate the recipient's TIN:
TIN: ________________________________
3. CONTRACTOR IDENTIFICATION NUMBER - DATA UNIVERSAL NUMBERING SYSTEM
(DUNS) NUMBER
(a) In the space provided at the end of this provision, the recipient should supply the Data
Universal Numbering System (DUNS) number applicable to that name and address. Recipients
should take care to report the number that identifies the recipient's name and address exactly
as stated in the proposal.
(b) The DUNS is a 9-digit number assigned by Dun and Bradstreet Information Services. If the
recipient does not have a DUNS number, the recipient should call Dun and Bradstreet directly
at 1-800-333-0505. A DUNS number will be provided immediately by telephone at no charge
to the recipient. The recipient should be prepared to provide the following information:
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(1) Recipient's name
(2) Recipient's address.
(3) Recipient's telephone number.
(4) Line of business.
(5) Chief executive officer/key manager.
(6) Date the organization was started.
(7) Number of people employed by the recipient.
(8) Company affiliation.
(c) Recipients located outside the United States may obtain the location and phone number of
the local Dun and Bradstreet Information Services office from the Internet Home Page at
http://www.dbisna.com/dbis/customer/custlist.htm. If an offeror is unable to locate a local
service center, it may send an e-mail to Dun and Bradstreet at globalinfo@dbisma.com. The
DUNS system is distinct from the Federal Taxpayer Identification Number (TIN) system.
DUNS: ________________________________________
4. LETTER OF CREDIT (LC) NUMBER
If the recipient has an existing Letter of Credit (LOC) with USAID or another US federal agency,
please indicate the LOC number:
LOC: _________________________________________
5. TYPE OF ORGANIZATION
The recipient, by checking the applicable box, represents that -
a) If the recipient is a U.S. entity, it operates as [ ] a corporation incorporated under the
laws of the State of _____________________________________________, [ ] an individual [ ]
a partnership, [ ] a non-governmental nonprofit organization, [ ] a state or local governmental
organization, [ ] a private college or university, [ ] a public college or university, [ ] an
international organization, or [ ] a joint venture; or
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b) If the recipient is a U.S. entity, it [ ] is, [ ] is not a Gray Amendment entity, as defined
below.
c) If the recipient is a Gray Amendment Entity, it is [ ] a business concerns (as defined in
48 CFR 19.001) owned and controlled by socially and economically disadvantaged individuals
(as defined in 48 CFR 726.101), [ ] an institution designated by the Secretary of Education,
pursuant to 34 CFR 608.2, as a historically black college or university (HBCU) , [ ] a college or
university having a student body in which more than 40% of the students are Hispanic
American, or [ ] a private voluntary organization which is controlled by individuals who are
socially and economically disadvantaged (as defined in 48 CFR 726.101).
d) If the recipient is a non-U.S. entity, it operates as [ ] a corporation organized under the
laws of ________________________________________________________ (country), [ ] an
individual, [ ] a partnership, [ ] a nongovernmental nonprofit organization, [ ] a
nongovernmental educational institution, [ ] a governmental organization, [ ] an international
organization, or [ ] a joint venture.
6. CERTIFICATION OF RECIPIENT
The potential grantee certifies that it agrees to comply with all ASF/ UAP and USAIDs rules
and regulations applicable to any potential grant agreement.
Solicitation (RFA) No. ___________________________________________________
Application No. _______________________________________________________
Date of Application ____________________________________________________
Name and Title of Potential grantee _______________________________________
Signature _________________________________________ Date ________________
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Annex F: Other Provisions
Part IStandard Provisions
Standard Provisions for Non-US Non-governmental Recipients are found at
http://www.usaid.gov/policy/ads/300/303mab.pdf
Part IISpecial Provisions
1. Value Added Tax (Vat) and Custom Duties
Pursuant to agreements with the Government of Pakistan (GOP), all imports and expenditures
under this award by the Grantee/Recipient and by non-local sub-grantees and subcontractors
(as defined below) will be exempt from Value-Added Tax (VAT) and customs duties imposed
by the GOP. Therefore, in accordance with paragraph 51 of OMB Circular No. A-122,
Attachment B, such VAT and customs duties shall not constitute allowable costs under this
award.
The Recipient and any non-local sub-grantees or subcontractors shall make reasonable efforts
to avoid Pakistani VAT at the point of sale by obtaining 0% VAT exemption. UAP and USAID
will assist the Recipient to obtain zero percent (0%) VAT status from the GOP. The Recipient
shall use this exemption to avoid paying any GOP VAT to local subcontractors and vendors by
obtaining approval from the GOP VAT Department for suppliers to issue 0% VAT invoices.
In cases where VAT cannot be avoided, the Recipient shall obtain original VAT receipts from
the vendors. Receipts must be submitted to UAP. UAP will submit those receipts to USAIDs
Financial Management Office on a monthly basis to enable USAID to process refund claimswith VAT authorities. The Grantee/Recipient is responsible for ensuring that sub-grantees or
subcontractors comply with this requirement.
All VAT claims for the sub-grantees and subcontractors shall be submitted to USAID through
UAP. Receipts for sub-grantees and subcontractors must be addressed to the project name /
name of the Grantee/Recipient to enable USAID to claim refunds.
Recipients that already have exemption mechanisms in place with the GOP should continue to
follow those procedures. Any refund of taxes received directly by the Recipient which were
allowed as award costs, should be credited either as a cost reduction or cash refund, asappropriate, to USAID.
"Non-local sub-grantees and subcontractors" means sub-grantees and subcontractors that are
present in Pakistan solely for the purpose of performing work financed by USAID or other tax-
exempt foreign donors.
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2. Reporting Of Foreign Taxes
(a) The awardee must annually submit one report by April 6 of the next year. The reporting
period will cover from October 1 to September 30.
(b) Contents of Report. The reports must contain:
(i) Applicant name.
(ii) Contact name with phone, fax and email.
(iii) Award number(s); separate report needs to be provided for each award.
(iv) Amount of foreign taxes assessed by the GOP on commodity purchase transactions valued
at $500 or more financed with U.S. foreign assistance funds under this agreement during the
prior U.S. fiscal year.
(v) Only foreign taxes assessed by the foreign government in the country receiving U.S.assistance are to be reported. Foreign taxes by a third party foreign government are not to be
reported.
(vi) Any reimbursements on the taxes reported in (iv) received by the recipient through March
31. Any refund from the GOP that is received directly by the awardee should be reflected. For
refunds processed by USAID, we will fill in the VAT refunded amount. If a VAT refund receipt
was provided to USAID for refund processing the awardee will need to provide the month
under which the claim was submitted to USAID and the serial number of the invoice as
included in the claim.
(vii) Reports are required even if the contractor/recipient did not pay any taxes during the
report period.
(viii) Cumulative reports may be provided if the contractor/recipient is implementing more
than one program in a foreign country.
(c) Definitions. For purposes of this clause:
(i) Agreement includes USAID direct and country contracts, grants, cooperat ive agreements
and interagency agreements.
(ii) Commodity means any material, article, supply, goods, or equipment.
(iii) Foreign government includes only a GOP entity.
(iv) Foreign taxes means value-added taxes and custom duties assessed by a foreign
government on a commodity. It does not include foreign sales taxes.
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(d) Where. Submit the reports in Email attachment to:
muslim.raza@asf.org.pk
(e) Sub-agreements. The awardee must include this reporting requirement in all applicable
subcontracts, sub-grants and other sub-agreements.
3. USAID Disability Policy - Assistance (December 2004)
(a) The objectives of the USAID Disability Policy are (1) to enhance the attainment of United
States foreign assistance program goals by promoting the participation and equalization of
opportunities of individuals with disabilities in USAID policy, country and sector strategies,
activity designs and implementation; (2) to increase awareness of issues of people with
disabilities both within USAID programs and in host countries; (3) to engage other U.S.
government agencies, host country counterparts, governments, implementing organizations
and other donors in fostering a climate of nondiscrimination against people with disabilities;
and (4) to support international advocacy for people with disabilities. The full text of thepolicy paper can be found at the following website:
http://www.usaid.gov/about_usaid/disability/.
(b) USAID therefore requires that the applicant not discriminate against people with
disabilities in the implementation of USAID funded programs and that it make every effort to
comply with the objectives of the USAID Disability Policy in performing the program under this
Sub-agreement. To that end and to the extent it can accomplish this goal within the scope of
the program objectives, the applicant should demonstrate a comprehensive and consistent
approach for including men, women and children with disabilities.
4. Implementation Of E.O. 13224 Executive Order On Terrorist Financing (March
2002)
The Applicant is reminded that U.S. Executive Orders and U.S. law prohibits transactions with,
and the provision of resources and support to, individuals and organizations associated with
terrorism. It is the legal responsibility of the applicant to ensure compliance with these
Executive Orders and laws. This provision must be included in all subcontracts/sub-awards
issued under this contract/agreement.
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Annex G: Documents required with grant application
Partnership / Sole Proprietorship
Copies of CNICs of all partners/proprietor
Bank statement (last six months)
Copy of NTN / Last filed Tax Return
List of major Customers / Suppliers (with
contacts)
Audited Financials (last 3 years)
Copies of Title Document/ Rent agreement
& utility bills of office premises
Ownership/ Lease documents for piece of
land where the project/activity will be
established
Letter(s) of commitment for matching the
funds (cost share) in cash or in-kind overthe life of grant from applicant or third
party duly signed by the Authorized
Organizational Representative stating the
exact amount of the matching funds or
value of the in-kind support that will be
contributed
Letter authorizing ASF/UAP to approach
applicants bank for information
Letter of proprietorship from bank (for
sole proprietorship) Copies of other Registration certificates, if
any (Sales Tax, Chamber Registration etc.)
Partnership Deed (for partnership)
Form C(if registered firm)
Any other information / document that
ASF/UAP may demand at any time
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Annex H: Cost sharing guidelines
ASF, pursuant to its Cooperative Agreement No. AID-391-A-12-00001 signed with USAID-
PAKISTAN, requires that in order to receive a grant, the grantee must provide a match in the
form of cash or in-kind contributions in an amount at least equal to the funds provided byUAP.
(A)All contributions, including cash and third party in-kind, shall be accepted as part of the
recipient's cost sharing or matching when such contributions meet allof the following criteria.
(1) Are verifiable from the recipient's records.
(2) Are not included as contributions for any other USAIDs assisted project or program.
(3) Are necessary and reasonable for proper and efficient accomplishment of project or
program objectives.
(4) Are allowable under the applicable cost principles.
(5) Are not paid by USAID-PAKISTAN under another award, except where authorized by US
Federal statute to be used for cost sharing or matching.
(6) Are provided for in the approved budget.
(7) Conform to other provisions of this part, as applicable.
(B) Values for recipient contributions of services and property shall be established in
accordance with the applicable cost principles. If USAID authorizes recipients todonate
buildings or landfor construction/facilities acquisition projects or long-term use, the value of
the donated property for cost sharing or matching shall be the lesser of:
(1) The certified value of the remaining life of the property recorded in the recipient's
accounting records at the time of donation, or
(2) The current fair market value. However, when there is sufficient justification, the USAID
Agreement Officer may approve the use of the current fair market value of the donated
property, even if it exceeds the certified value at the time of donation to the project.
(C) Volunteer services furnished by professional and technical personnel, consultants, and
other skilled and unskilled labor may be counted as cost sharing or matching if the service is
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an integral and necessary part of an approved project or program. Rates for volunteer services
shall be consistent with those paid for similar work in the recipient's organizations. In those
instances in which the required skills are not found in the recipient organization, rates shall be
consistent with those paid for similar work in the labor market in which the recipient
competes for the kind of services involved. In either case, paid fringe benefits that are
reasonable, allowable, and allocable may be included in the valuation.
(D)When an employer other than the recipient furnishes the services of an employee, these
services shall be valued at the employee's regular rate of pay (plus an amount of fringe
benefits that are reasonable, allowable, and allocable, but exclusive of overhead costs),
provided these services are in the same skill for which the employee is normally paid.
(E)Donated supplies may include such items as expendable equipment, office supplies,
laboratory supplies or workshop and classroom supplies. Value assessed to donated supplies
included in the cost sharing or matching share shall be reasonable and shall not exceed the
fair market value of the property at the time of the donation.
(F)The method used for determining cost sharing or matching for donated equipment,
buildings and landfor which title passes to the recipient may differ according to the purpose
of the award, if:
(1) If the purpose of the award is to assist the recipient in the acquisition of equipment,
buildings or land, the total value of the donated property may be claimed as cost sharing or
matching, or
(2) If the purpose of the award is to support activities that require the use of equipment,
buildings or land, normally only depreciation or use charges for equipment and buildings may
be made. However, the full value of equipment or other capital assets and fair rental charges
for land may be allowed, provided that the USAID Agreement Officer has approved the
charges.
(G)The value of donated property shall be determined in accordance with the usual
accounting policies of the recipient, with the following qualifications.
(1) The value of donated land and buildings shall not exceed its fair market value at the time
of donation to the recipient as established by an independent appraiser (e.g., certified real
property appraiser or General Services Administration representative) and certified by a
responsible official of the recipient.
(2) The value of donated equipment shall not exceed the fair market value of equipment of
the same age and condition at the time of donation.
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(3) The value of donated space shall not exceed the fair rental value of comparable space as
established by an independent appraisal of comparable space and facilities in a privately-
owned building in the same locality.
(4) The value of loaned equipment shall not exceed its fair rental value.
(i) The following requirements pertain to the recipient's supporting records for in-kind
contributions from third parties.
(1) Volunteer services shall be documented and, to the extent feasible, supported by the same
methods used by the recipient for its own employees,
(2) The basis for determining the valuation for personal services, material, equipment,
buildings and land shall be documented.
Non-auditable contributionsmay not be used to meet the minimum cost sharing or matching,
but can be indicated separately and attached to the budget detail form. A grant will not be
issued unless all matching funds over the life of the grant are secured with letters of
commitment. For third party cash or in-kind support, letters of commitment must be
submitted on donor organization letterhead, must include the signature of the Authorized
Organizational Representative (AOR), and must state the exact amount of the matching funds
or value of the in-kind support that will be contributed. There can be no stipulationson the
matching amount.
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INELIGIBLE EXPENSES
UAP grant funds may not be utilized for the following:
Profit
Military equipment
Surveillance equipment
Commodities and services for support of police and other law enforcement activities
Abortion equipment and services
Luxury goods and gambling equipment
Weather modification equipment
Private ceremonies, parties, celebrations, or "representation" expenses
(entertainment costs)
Purchases of restricted goods, such as agricultural commodities, motor vehicles,
pharmaceuticals, contraceptive products, pesticides, used equipment and fertilizers
without USAIDs AO approval.
Purchases of goods or services from countries1or suppliers as may be identified by
USAID's consolidated list of debarred, suspended, or ineligible subcontractors at
http://www.epls.gov/ or the United Nations Security (UNSC) sanctions committee
established under UNSC Resolution
(http://www.un.org/Docs/sc/committees/1267/1267ListEng.htm)
Prior obligations of and/or, debts, fines, and penalties imposed on the Grantee.
Grant or sub-grant assistance to the Government of Pakistan, including federal,
provincial, divisional, district, and other local government units without a Mission
director deviation from ADS 303.
Alcoholic beverages
Purchases or activities unnecessary to accomplish grant purposes as determined bythe UAP.
1 As of March 2011 the foreign restricted countries are: Cuba Iraq Iran Laos Libya North Korea and Syria