FGIS 4 Application and Agreement for Contract Service

This is a fillable form; fill out, print, sign original, and mail to service area GIPSA Field Office.
OMB No. 0580-0013
No reduced hourly fee may be approved unless this
application has been properly completed (7 CFR 800.115 (c)).

UNITED STATES DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND STOCKYARDS
ADMINISTRATION
FEDERAL GRAIN INSPECTION SERVICE
WASHINGTON, DC

Name of Applicant

FORM APPROVED OMB NO. 0580-0013: According to the
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DQGDSHUVRQLVQRWUHTXLUHGWRrespond to a collection of information
XQOHVVLWGLVSOD\VDYDOLGOMB control number. The valid OMB control number for
WKLVinformation collection is 0580-0013. The time required to
complete this information collection is estimated to average 20
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.

APPLICATION AND AGREEMENT FOR CONTRACT SERVICE
Location of Service
Date of Service to Commence

The above named applicant hereby makes application for official inspection and/or official weighing(s) in accordance with
applicable provisions and conditions stated below:
I.

The contract and the services shall be subject to the United States Grain Standards Act, as amended,
(7 U.S.C. 71 et. seq.), hereinafter cited as the Act, and the regulations, standards, and instructions thereunder.

II.

The applicant agrees that with respect to:
A.

1 YEAR CONTRACT RATE – To pay the current contract rate for 8 hours of service per day, per
contracted personnel for a specified shift, _____ consecutive days (5 days minimum) per week
beginning on _________, for 1 calendar year from the effective date of the contract. The fees are
published in the regulations under the Act.

B.

NONCONTRACT RATE – To pay the current noncontract rate for all noncontracted hours worked. The
fees are published in the regulations under the Act.

C.

CONTRACTED PERSONNEL – To pay the contract rate for:
1. ___________ official personnel for the first shift for 8 hours per day.
2. ___________ official personnel for the second shift for 8 KRXUVper day.
3. ___________ official personnel for the third shift for 8 hours per day.

III.

GIPSA/FGIS agrees that with respect to:
A.

SERVICES – To furnish official personnel to perform service for the applicant at the specified location in
accordance with the Act.

B.

CHARGES – To bill the applicant at the current contract hourly rate for the contracted hours and
noncontracted hourly rate for all other hours worked in accordance with the fees published in the
regulations under the Act.

C.

UNCONTROLLABLE CIRCUMSTANCES – Charges shall not be assessed when service is not
performed due to strikes, natural disasters, fires, bomb threats, or other situations not under the control
of applicant.

________________________________________________________________________________________________
Form FGIS-4 (11/03)([SLUHVxx/xx/20xx

IV.

It is mutually agreed that with respect to:

A.

OFFICIAL PERSONNEL –

B.

C.

1.

GIPSA/FGIS reserves the right to determine the total number of official personnel needed to
perform the service.

2.

GIPSA/FGIS reserves the right to reassign official personnel when, in the opinion of
GIPSA/FGIS, the personnel are not needed to perform service for the applicant or when the
applicant and FGIS agree services are not needed. In these circumstances, the applicant will
not be charged for the hours of employees that are reassigned.

TERMINATION OF CONTRACT – The official services shall be provided at the specified location and
shall be continued for a specified contract period unless the contract is terminated prior to this time by:
1.

Either party giving the other 60 days advance written notice of termination, unless it is mutually
agreeable to both parties to terminate it at an earlier date. If the applicant terminates the
contract, then the applicant forfeits the privilege of signing a new contract for the specified
contract period.

2.

The applicant notifying GIPSA/FGIS of termination 10 days prior to the effective date of revised
inspection and/or weighing contract hourly fees.

RENEWAL OF CONTRACT – The applicant will give not less than 10 days written notice of intent to
renew the contract for a specified contract period.
1.

V.

AMENDMENT OF CONTRACT – By mutual agreement, a contract may be amended as to the
number of official personnel under the contract.

This application when approved shall constitute a contract between the undersigned applicant and GIPSA/FGIS,
in accordance with the terms and conditions provided herein, and shall supersede any pervious executed
contract(s) for official inspection and/or official weighing services(s) covering the same location and applicant.
APPLICANT
Name of Firm
Signature

Title

Date

APPROVED
U.S. Department of Agriculture, Grain Inspection, Packers and Stockyards Administration,
Federal Grain Inspection Service
Field Office (City and State)
Signature of Authorized Field Office
Representative

Title

Date

Clear Form

Form FGIS-4 (11/03) Reverse

INSTRUCTIONS FOR SUBMITTING A CONTRACT SERVICE AGREEMENT
A.

Applicants for grain inspection and weighing services in areas served by a Federal
Grain Inspection Service (FGIS) field office may enter into a service commitment
with the field office in order to ensure timely services and to obtain lower
inspection and weighing charges.
1.

A commitment (contract) service is an agreement whereby the applicant
agrees to pay for 8 hours of service per day for a predetermined number of
official personnel, for at least 5 consecutive days per week.

2.

FGIS in turn, agrees to make official personnel available to the applicant
for the specified period and to perform all requested services at reduced
hourly rates.

3.

All hours of service worked in excess of the commitment are charged at
the no commitment rate.

4.

Service charges are not assessed under commitment service for recognized
federal holidays when, upon request of the applicant, service is not
performed. The applicant is requested to make this request not later than 2
p.m. the preceding business day.

B.

To enter into a commitment service agreement, the applicant must provide the
appropriate FGIS field office with 60 days written notice specifying the proposed
effective date of the commitment. A commitment may become effective prior to
the proposed effective date with the consent of both parties.

C.

To terminate a commitment service agreement, the applicant must provide the
appropriate FGIS field office with 60 days written notice specifying the date of
termination. However, a commitment agreement may be terminated at any time
by mutual consent of both parties.

D.

FGIS reserves the right to:
1.

Determine the number of official personnel needed to perform the service
for a commitment applicant, which may be different than the number of
official personnel under commitment;

2.

Terminate a commitment agreement by giving the applicant 60 days
written notice specifying the date of termination; and

3.

Temporarily reassign official personnel from a commitment applicant
when, in the opinion of FGIS, the official personnel are not needed to
perform service for the commitment applicant.

NOTE: Charges will be assessed in accordance with Section 800.71, "Fees assessed by
the Service," of the regulations under the United States Grain Standards Act, as amended.
CONTACT INFORMATION:
Contact the field office responsible for the geographic area in which the service will be provided.
Details for these locations can be found at:
http://www.usda.gov/gipsa/aboutus/servicemap/usmap.htm
The signed form should also be mailed to this location.
For further information on Contract Service Agreements contact:
Robert Lijewski, Director
Field Management Division
1400 Independence Avenue, SW, Room 2409 N
Washington, DC 20250-3630
Telephone:
Fax:
Email:

(202) 720-0228
(202) 720-1015
robert.s.lijewski@usda.gov