Florida Department of Agriculture and Consumer Services Division of Food, Nutrition and Wellness

FDACS-06448 Rev. 08/12 Page 1 of 2

NATIONAL PROCESSING AGREEMENT (NPA) STATE PARTICIPATION AGREEMENT (SPA)

Please return to: Florida Department of Agriculture and Consumer Services Bureau of Food Distribution 407 S. Calhoun Street Mayo Building, M-39 Tallahassee, Florida 32399-0800 Phone: (850) 617-7170 Fax: (850) 617-7171

NICOLE "NIKKI" FRIED COMMISSIONER

UPDATE FOR SY 2012-2013 7 CFR 250

PROCESSOR NAME: PROCESSOR #: FEID#:

I affirm that this company wishes to continue participating in the USDA Foods processing program. I understand that the terms and conditions in our agreement(s) remain the same unless notified in writing by the Bureau of Food Distribution.

Please update the following information and return to the Bureau at the address above:

Are you currently approved by the United States Department of Agriculture (USDA) for participation under the National Processing Agreement (NPA/SPA)? No If no, please proceed to section B. below

Yes - Florida SPA Agreement #:

A. All Processors: Value Pass Through (VPT) Systems (check all that apply): Direct Sale Refund to Recipient Agency

Net Price Through Distributor (NOI) Alternate Value Pass Thru System (requires FNS approval)

Fee-for-Service-billed by processor For-for-Service-billed by distributor

1. If you checked NOI above, have you submitted your sales verification plan to the Bureau of Food Distribution?

No Yes If yes, attach a copy of your sales verification plan.

2. Do you currently contract with a subcontractor? No Yes If yes, please identify the subcontractor by name,

address and USDA plant number for each item produced.

3. Are you using a distributor? No Yes If yes, please provide name and address.

4. Verification of All Processing Locations for Florida’s USDA Foods Required: Please provide the Business Partner-IDnumber(s) for ALL processing site(s) [i.e., your “ship to” site(s)], for each USDA Food material code, by completing item #1on the accompanying “Revised Checklist”, so we can ensure all are mapped properly in the USDA’s WBSCM system.

B. Contact Person:

Title:

Telephone: Fax: E-mail:

This agreement must be signed by the owner, partner or corporate officer duly authorized to sign contractual agreements. If an employee other than these specified individuals signs this agreement, a power of attorney indicating the employee’s authority must accompany this agreement.

Signature: Title:

The Catalog of Federal Domestic Assistance (CDFA) reference for this program is Food Distribution, Number 10.555

“In accordance with Federal Law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call toll free (866) 632-9992 (Voice). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.”

FDACS-06448 Rev. 08/12 Page 2 of 2

Florida Department of Agriculture and Consumer Services Division of Food, Nutrition and Wellness

Bureau of Food Distribution

SY 2012-2013 State Participation Agreement (SPA)

UPDATE CHECKLIST

To help ensure that all required components of your SY 12-13 SPA UPDATE have been completed and all needed documents included, check off (or mark N/A for not applicable) each item listed below. Return the required documents with this checklist on top to the Florida Department of Agriculture and Consumer Services, Bureau of Food Distribution for approval. Do not submit a partial agreement package. Your agreement will not be approved unless the entire package is completed as instructed. Note: We are able to accept e-mail submission of all forms, including signed documents.

1. ___ Because we have to verify and update our records, please list ALL processing sites (i.e., “ship to” sites)used for Florida’s USDA Foods by Material Code in the chart below..

WBSCM Material Code

Item Code (Old ECOS)

optional

Processing Location (PL) City

PL State WBSCM-Issued BP-ID #

2. ___ Completed and signed NPA/SPA SY 12-13 UPDATE form

3. ___ Value Pass-Through (VPT) System(s) for SY 12-13 selected

4. ___ Sales Verification Plan attached if net price through distributor (NOI) was selected in #3 above

5. ___ USDA-approved Summary End Product Data Schedules (SEPDS) e-mailed in Excel format toPatti.Askins@freshfromflorida.com

6. ___ Subcontractor information completed (if applicable)

7. ___ Broker and/or distributor information provided (if applicable)

8. ___ Hold/Recall or Disaster Contact Information Sheet completed and attached

9. ___ A Substitute Form W-9 has been filed with myfloridacfo.com for validation by the Internal RevenueService (IRS)

Signature of the Authorized Representative for the Processor Date Signed

Printed Name of the Authorized Representative for the Processor Printed Name of the Processor