- Green Coffee Association Inc.

I Green Coffee FOB, C&F , CIF contracts

All parties agree this contract is subject to the terms and conditions of the Green Coffee Associati on Inc.
Date:
August 5, 2015
Producer I FLO 10:
6589
Permata Gayo Coop
Syiah Utama Street,
Simpang Utama Village No 61
Bandar Sub-District
Bener Meriah District, NAD, Indonesia
armia mdn@yahoo .co. id
280
Kg I bag :
16,800 .00 Lbs total :

Contract No :
SUG167 -Buyer:
I FLO 10:
1341
Cooperative Coffees Inc.
302 W . Lamar St
Americus GA 31709, USA
Tel : 514 907 9853
Fax: 2299246250
florent@coopcoffees.com

U..p

da::leJ

132

Quantity

Bags :
Kg total :

Quality

Origin:
Sumatra Coop:
Permata Gayo Harvest:
2015-2016
Type :
Green arabica specialty quality coffee , Gayo
Preparation: European
Moisture Content:
10% - 12%
Certification (s):
Fair Tade FLO certified and Organic NOP certified
Note: To be bagged in Grain Pro Bags

Price

To be fi xed with an average of the NYC in the 30 days prior shipping date
NYC Mar 16 + Fair Trad e Prem o0,20 $US per Ib + Org .Prem . 0,30$US per Ib + Dif. 0.50 $US per Ib
OR minimum guaranteed price of 2.20 $US l ib . (1.50 $US + FT premo0. 20 $US per Ib + Org prem 0. 30 $U S
Inconterm:
FOB Belawan , Medan Closed at $2.41 on February 17, 2016
Qualitty premium : 0.05 $US pr Ib if landed sample is 84 pOints and above.
Do you request pre-financing for this contract?
YES
NO
When do you expect to receive pre-financing?
Which is your preferred solidarity lender?
Pre financing will be provided by a solidarity lender and interest will be. charged to the seller

Financing

60
36,960 .00

Lbs I bag

Weight

Shipped weights, 1/2% franch ise

Payment

Full payment upon first presentation of all original documents including organic transaction certific

Insurance

To ship covered by seller. From Ship to US port covered by buyer

Shipment

Belawan
Date:
February 2016
Port of:
TO SHIP IN THE SAIVIE CONTAINER WITH SUT162 CONTRACT
New York, NY, US

Destination

Pre-shipment sam ple required. To be drawn from at least 100% of the contract's quantity
Landed coffee will be approved within 15 days following the date of discharge in buyer's warehou:
Thi s coffee was traded according to international Fair - Trade criteria as established by FLO
Organic Certification documents by NOP agency recognized required before payment
Certificate of Origin required before payment
Bags must be marked with "Organic", "FLO Fair Trade", and with producers' coop FLO 10
Bags must be marked with Producers' coop logos , and Cooperative Coffee logo (if possible) or n,
If any, arbitration in accordance with the rules of arbitration of the Green Coffee Association Inc.

Remarks

/1

/ 1 pro;;.IJ.Jcers
Signalj

/;

r:::

'?

Name :
/
Date : November 14, 2015

Buyer
Signature:
Name:
Date:

Florent Gout
August5 , 2015

Green Coffee Association Inc. / Green Coffee FOB, C&F, CIF contracts
All parties agree this contract is subject to the terms and conditions of the Green Coffee Association Inc.
August 5, 2015
Date:
Producer
FLO ID:
6589
Permata Gayo Coop
Syiah Utama Street,
Simpang Utama Village No 61
Bandar Sub-District
Bener Meriah District, NAD, Indonesia
armia_mdn@yahoo.co.id
40
2,400.00

SUT162
Contract No:
Buyer:
FLO ID:
1341
Cooperative Coffees Inc.
302 W. Lamar St
Americus GA 31709, USA
Tel: 514 907 9853
Fax: 229 924 6250
florent@coopcoffees.com
Lbs / bag

132

Bags:
Kg total:

Quality

2015-2016
Sumatra Coop: Permata Gayo
Origin:
Harvest:
Green arabica specialty quality coffee, Gayo
Type:
Preparation: European
100% red cherries / Bourbon, with floating test to remove unripe. 85 pts SCAA
Quality:
Moisture Content:
10% - 12%
Fair Tade FLO certified and Organic NOP certified
Certification (s):
Note: To be bagged in Grain Pro Bags

Price

Weight

To be fixed with an average of the NYC in the 30 days prior shipping date
NYC Mar 16 + Fair Trade Prem. 0,20 $US per lb + Org.Prem. 0,30$US per lb + Dif. 0.95 $US per lb
OR minimum guaranteed price of 2.65 $US / lb.
Inconterm: FOB Belawan, Medan Closed at $3.06 on February 17, 2016
Do you request pre-financing for this contract?
YES
NO
When do you expect to receive pre-financing?
Which is your preferred solidarity lender?
Pre financing will be provided by a solidarity lender and interest will be charged to the seller
Shipped weights, 1/2% franchise

Payment

Full payment upon first presentation of all original documents including organic transaction certificate

Insurance

To ship covered by seller. From Ship to US port covered by buyer

Financing

Kg / bag:
Lbs total:

60
5,280.00

Quantity

Feb-16
Belawan
Date:
Port of:
TO SHIP IN THE SAME CONTAINER WITH SUG167 CONTRACT
Destination New York, NY, US
Shipment

Remarks

Pre-shipment sample required. To be drawn from at least 100% of the contract's quantity
Landed coffee will be approved within 15 days following the date of discharge in buyer's warehouse
This coffee was traded according to international Fair - Trade criteria as established by FLO
Organic Certification documents by NOP agency recognized required before payment
Certificate of Origin required before payment
Bags must be marked with "Organic", "FLO Fair Trade", and with producers' coop FLO ID
Bags must be marked with Producers' coop logos, and Cooperative Coffee logo (if possible) or name
If any, arbitration in accordance with the rules of arbitration of the Green Coffee Association Inc.
Producers

Buyer

Signature:

Signature:

Name:
Date:

Name:
Date:

Florent Gout
August 5, 2015

KOPERASI SERBA USAHA

PERMATA GAVO
BADAN HUKUM :No.51&(}39/ BH/Il I/l006
Jalan :Syia hUtama No. 66 SimpangUtama Bene rMeriah
ACEH - INDONESIA

KOPERASIINDONESIA

OOPERATIVE COFFEES, INC

302 W, Lamar St. Suite E. Americus, GA 31709 USA
Tel. +1-229-924-3035 , Fax.+1 -229-924-6250
Attn : Chelsea Carter

PERMATA GAVO COOP

Shipped by:
WILLI V.HE608R
From:
BELAWAN, INDONESIA

FLO 10 6589
Contract No.
FLO 10 buyer: 1341
SUG167
REG NO.13096723740
S/L Number:
GIBLW1600010
2016
To:
NEW YORK NY USA

Consignee:
TO THE ORDER OF COOPERATIVE COFFEES INC

Container/Seal No:
MEDU3553698 / FEJ7398659

302 W, Lamar St. Suite E. Americus, GA 31709 USA

Connecting Vessel:
MAERSK SARNIA V.608W

Tel. +1 -229-924-3035, Fax.+1-229-924-6250

Attn: Chelsea Carter

Description of Goods

280 (two hundred eighty) Bags

of 60 Kgs Net Each Bag+ Grain Pro Bag

SUMATRA PERMATA GAYO HIGH LAND

ARABICA DP GRADE 1 GREEN COFFEE

FLO FAIRTRADE & ORGANIC CERTIF IED

Gross Weight
Nett Weight
Price
Organic Premium
FairtradePremiun
Price total
Total FOB

: 17,080Kgs
: 16,800Kgs
US$.

: US$. 4,210.79/Mtons
: US$.
661.38/Mtons
:US$.
440.92/Mtons
: US$. 5,313.09/ Mtons ------FOB

US$.
US$.
US$.

70,741.27

11,111 .18

7.407.45

89 /259.90

c&F NEW YORK/ NSW as per contract no.SUG167

Say : Eighty NlneThousand Two Hundred Rfty Nine and Cents ninety
USDa/larsOn/Yo
- Insurance to be covered by buyer
-Freight Prepaid -Payment C.A.D
- "This cargal coffee has not been refused entry by any country"
Please cable our money to our Bank as bellow :
pay to:Bank of New York, New York, BIC:IRVTUS3N
For : Credit Suisse Zuerich, account nO.:8033342099 BIC :CRESCHZZ80A
For fina l Beneficiary : responsAbllity Fair Agriculture Fund
IBAN no. : CH66 0483 5137 3563 7200 0
Marks & Nos.

PGC

olSIl730/25
SUO 167
FLO 1D. 1341
SUMATRA GAYO MOUNTA
GREE ARAB I A COFFEE DP GRADE 1

"NO HOOKS"

FAIR TRADE FLO ORGAN IC CERTIFIED

ID CU. R1 2234

FLO!D : 6589

PROD OF [NOO ESIA

ETT60 KGS

EW YORK. Y
1-280

Notify Party:
EXCElCO TRAD ING L.P.
17 BATIERY PLACE, SU ITE 1010
NEW YORK,NY 10004
TEL. + 1-212-344-6771,FAX. + 1-212-344-8723
ATTN : AMADEUS EHRH ARDT
(AEHRHARDT@ EXCELTRADE.COM)

1. A_ :

KOPERASI SERBA USAHA

PERMATA GAYO
BAOAN HUKUM :No.51&{)39/BH/ II!i2006

Jalan :Syiah Uta ma NO.66 Sim pangU t amaBenerMe riah

ACEH - INDONESIA

KOPERASIINDONESIA

PERMATA GAYO COOP

COMMERCIAL INVOICE
dd.25/02/20 16

Messrs.

Invoice No.

COOPERATIVE COFFEES . INC

302 W. Lamar Sf. Suite E Americus, GA 31 709 USA
Tel. +1-229-924-3035, Fax +1 -229-924-6250
Attn: Chelsea Carter

026/ INVIPGC/ 20 15/20 16

Shipped by:

B/L Number:

WILLI

GIBLW1600010

V.HE608R

Contract No.

FLO ID 6589
FLO 10 buyer: 1341
FDA REG NO.13096723740

SUT162

OD.28/02/2016

From:

To:

BELAWAN, INDONESIA

NEW YORK, NY - USA

Consignee:

Container/Seal No:
MEDU3553698 1 FE.J7398659
Connecting Vessel:

TO TH E ORDER OF COOPERATIVE COFFEES INC

302 W, Lamar St. Su ite E Americus, GA 31709 USA
Tel. +1-229-924-3035, Fax.+ 1-229-924-6250
Attn: Chelsea Carter

MAERSK SARNIA V.608W

Description of Goods
40 (forty) Bags

of 60 Kgs Net Each Bag+ Grain Pro Bag

SUMATRA PE RMATA GAYO HIGHLAN D

ARAB1CA SPECIALTY DP GRADE IGREEN COF FEE

FLO FAIRTRADE & ORGAN IC CERTIFI ED

Gross Weight
Nett Weight

: 2,440Kgs
: 2,400Kgs

Price
: US$. S,665.82/ Mtons
Organic Premium : US$.
661.38/Mtons
FairtradePremiun :US$.
440.92iMtons
: US$. 6,768.12/ Mtons ------FOB
Price total
Total FOB

C&F NEW YORK, NSW as

US$.
US$.
US$.
US$ .

13,597.97
1,587.31
1,058.20
16,243.48

per contract no.5UT162

Say : Sixteen Thousand TwoHundred Forty Three and Cents Forty Eight
USDa/larsOn/Yo
Insurance to be covered by buyer
-Freight Prepaid -Payment CAD
- "This ca rgo / coffee has not been refused entry by any country"
-

Please cable our money to our Ba nk as bell ow :

pay to:Bank of New York, New York, BIC:IRVTUS3N

For : Credit Suisse Zuerich, account no.:8033342099 BIC :CRESCHZZ80A
For final Beneficiary : responsAbility Fair Agriculture Fund
IBAN no. : CH66 0483 5137356372000
Marks & Nos.

Notify Party:
PGC

EXC ELCO TRADING l. P.

OJ 5/17 30/26

17 BATIERY PLACE, SUITE 1010

SUT 162

NEW
YORK,NY 10004
FLO ID. l341

TE L. + 1-212-344-6771,FAX. + 1-212-344-8723
SUM TRA GAYO MOUNTAIN

GREEN ARABICA COFFEE

ATTN : AMA DEUS EHRHAR DT

SPECIALTY DP GRADE I

(AEHRHAR DT@EXCElTRADE.COM )
, OHOOKS"

FAIR TRADE FLO + ORG ANIC CERTIFIED

ID CU. 81 2234

FLO ID . 6589

PROD OF INDON ESIA

NETT 6() KGS

NEW YORK. Y

1-40

KOPERASI SERBA USAHA

A 0

BADAN HUKUM No.51&Q39/BH/II I/l006

Jala n :Syia hU tama NO.66 Sim pangUtamaBenerMeriah

CfH

KOPERA511NDONESIA

DO fS A

PERM ATA GAYO COOP

COMMERCIAL INVOICE

025a-026a/INV/PGC!II!1016
dd.2~2/l016

COOPERATI VE COFF EE INC

30 2 W LAMA R ST SUITE E AM AER ICUS , GA 3 1709 USA TEL:+1
229-924 -3 035 , FAX :+1-229-9 24-6250
ATTN: CHElSEA CAR TE

T\)tal Vallie an I

PUl:kage
Numhl'r

Full Description of Go d

320 pieces

Grain Pro Bags

US$ 1,920.00

Ocean Freight Cbarger

US$ 2.850.00
US$ 4,770.00

Cllrrency

(Say: FOllr Thousand and Seven Hundred

Sevenl)- .US Dollars Only}
Please cable our money to our Bank as bellow:
pay to: Bank Internasional Indonesia Krakatau Medan Branch
for: Koperasl Permata Gayo, Accoun t no. 2.208.0028.4

BIC: IBBKIDJA

ayo

( lr. Armia )

. , TRANSGLOBAL LOGISTICS INC

COMBINED TRANSPORT BILL OF LADING

NOT NEGOTIABLE UN LESS CON SIGNED "TO OR DER"
BOO KING ,..10

StilPPERI EXPORlER ICOMPlfTF NAML AND ADDRESS1

KOPERASI PERMATA GAYO

JL.SYIAH UTAMA NO.66 KAMPUNG SIMPANG UTAMA
KEC. BANDAR, KAB. BENER MERIAH.
ACEH-24582 INDONESIA

GIBLW1800010
[XPORTRU [ RE N([S

CON SIGNEE \If 'TO ORDE~' SO INmCATE!

FORWARD ING AGEN T FMC NO:

TO THE ORDER OF COOPERATIVE COFFEES INC

302 W.LAMAR ST. SUITE E AMERICUS. GA 31709 USA
TEL+1,229-924-3035, FAX. +1-229-924-6250
ATTN: CHELSEA CARTER FLO 10 : 1341

TGL OTI NUMBER : 019970NF

AP PLIC ATIO N FOR

OEltVE ~Y

MUS1 BE MADE TO

TRANS GLOBAL LOGISTICS INC

30 KNIGHTSBRIDGE ROAD, SUITE 525
PISCATAWAY NEW JERSEY - 08854
TEL : 732 640 2980
FAX : 732 640 2982
PIC : MS. SHllNI mail: shilni@trglinc.com

NOnFY \NO CLAIM SHAl l I,H ACH fOR rAl lURE TO NOTlr y)

EXCELCO TRADING L.P.

17 BATTERY PLACE, SUITE 1010 NEWYORK.NY 10004
TEL. + 1-212-344-6771 FAX. + 1-212-344-8723
ATTN: AMADEUS EHRHARDT (AEHRHARDT@EXCElTRADE.COM)

PLACE Of RfClPT

PRECARRI AGE BY

WILLI V.HE60BR

BELAWAN. INDONESIA
PORl OF LOADIN G

EX PORT CARRI ER \VESSEl . V OAG ~

MAERSK SARNIA V.

8,1 LOF lADING NO

8W

LOADI NG PIER/ToRMINA I.

BELAWAN, INDONESIA

PORT Of DIS(,HARG~

PLACE OF DElIVERY BI' ON CAR RIER

NEW YORK. USA

TYP E DF MOVE

NEW YORK, USA

CY/CY
PARTICULARS FUR NISHED BY SHIPPE R

MARKS & NOS.I CONTAINE R NOS

CONTR NO I SEAL
MEDU3553698
FEJ7398659

SAID TO CONTAIN
DE SCRIPTION OF PACKAGES AND GOODS

NO. OF PKGS

320 BAGS

PGC

015/1730125
SUG 167

FLO 10 : 1341

SUMATRA GAYO MOUNTAIN

GREEN ARABICA COFFEE
DP GRADE 1
"NO HOOKS
FAIR TRADE FLO ...
ORGANIC CERTIFIED
10 CU : 812234
FLO ID : 6569

PROD OF INDONESIA 0)

G. W

SHIPPER'S LOAD. STOW. COUNT, Vv'EIGHT & SEALED

1X20'FCl: 320 BAGS IN A TOTAL :
280 BAGS OF 60 KGS NET EACH BAG SUMATRA PERMATA

GAYO HIGHLAND ARABICA DP GRADE 1 GREEN COFFEE

FLO FAIRTRADE & ORGANIC CERTIFIED N.W 16.800 KGS

40 BAGS OF 60 KGS NET EACH SUMATRA PERMATA

GAYO HIGHLANDARABICA DP GRADE 1 SPECIALTY

.COFFEE GREEN FLO FAIRTRADE & ORGANIC CERTIFIED

N.w 2.400 KGS

FDA REG NO. 13096723740

.) NETT 60 KGS
NEW YORK

1 - 260
PGC

01511730/26
SUT162
FLO 10 : 1341
SUMATRA GAYO
MOUNTAIN
GREEN ARABICA COFFEE

19520.000 KGS

N. w.:
19200.000 KGS

SPECIAL TV DP GRADE 1
"NO HOOKS
FAIR TRADE FLO ...
ORGANIC CERTIFIED
10 CU : 812234
FLO 10: 6589
PROD OF INDONESIA
NETT60KGS
NEW YORK. NY
1 - 40

\11' ..\'~GT
NO OF ORIG1NAL Bt's : ." \

FRE IGHT PAYABLE AT

PRE PAI D

FREIGHT & CHA RGES

ORIEINAl

1 EM PER ATURE CON TROL INSTRUCTION

EXIT,S VALUE OECLARATION :
REFER TO CLAUSE 6( 3)(B) + (C) ON REVERSE SIDE

MEASUREMENT

GROSS WEI GHT

COLLECT

''-'-I

try Ih e Carner Ihl! GDo d s 015 'poI!t"l fISQ ~tlove ,.,

o'de r and cond.i!!crn unten: Il tt U!l\~ I!ltt " Inlet) to
b(ll l ran!:p:::Jf1('!<l l0JJ.lcn p 1ac-e a~ .agrt!lod aolnorl.c:ad or ~ 1 'T'lttO(l
UfOl.
"t IUbjt'lc t to ,)tlll1~ term!'! s nd cond,l.ons ap[lIUlrnl,l ry
the r'OII I d nd rev'!'se Of this Bll1Qf L.fldu'\l] 10 w ~ l rh Ihe ..ton:I'IoI:\l1t
IIgr89. tv, Hec~plff'lg Itll" Sltit or L- ;,d n Q any lor::~I.,mdl'loQe..i and
cUl!ll.oms ,,0~'l t h&".iII1'1all'1!1 j"... I'IFHlIc:ul()fl 9 ...... " aDDOJe .~B 8S
RECflvt;

tu~p .H"r\l ~ood

Ii .

!I.'' ' '!C!

hy lh@

~h;pp.e'

..... iJ, 111ft

'm.!" ~". 1

. ~~a6UI4t.

a....a nH y

condl l lon eon l entlli ana OJaIU' ('If ,h. goods arft un;.;no .... n 10 the
L'ur.' l~ >\>llnen .....1': I""IHrr !j Ill. t' I t'l-ti'Q'l\lIt tN I ~ ' Lsrdmg n il S
befln !Ignec H nol ethan ",' a.8 sln l ad oonvo th. ",fI\~ bem9
llCC('lmpll'tH~d fn.. cU'I.rr.s). dl1't to !)I . '{(:I'd
! HlI~UI'8d bv tn",
GHf'ler nne It) onglnal Sill o~ UOIl'ln mu,'llft 1!;umu'roerifd dr.lly
endOfst"d In " w;ct. nqe fo / In~ ~r,)OtJ_ Or dfll,'i'P Y crt1Q r

FREIGHT PREPAID

SaQnad on DeM I of

TRANSGLOBAL LOGISTICS INC

r

JURIS DI CTION & LAW CLAUSE.

JURISDICTION
l tJ". Ctll'U"U l:vldeollr:cd bv o r COl"tiJlnf."d" ~ h l\ 6ill of ~"d l "~ I, lI:ulJ~rne d b~ t il!:! Lw .' o f Unite-Ii Stales o f AmE!'nQ <1 nd '"In.,. dal m or d l~pLlte anSiIO

hereunde, of I" connecti on h-er l!wilh sh.ill bE' determined bv thp. Ufl lte d $tttll!S ff'der.11 (ou rt ot the S ou t n~m DI'it nct 01 New York and 00 other court';

BV

t-~

, ~8 FEB. 2016

T RANSACTION CERTIFICATE
USA FOR PRODUCTS FROM l'iOP ORGANIC PRODUCTION

COIllrol Un io n Ccrt ili cal i()ll-.. B.V.

2 a) The National Organi c Pro gram _~t ~l!llia r (b of the United Slates Departrnent of
Agri culture/Control Uni on Cl..:rtilicat loll ~ standards

Meeu wl' Tl laall 4-6

2 b ) Reference number of the cer()flcat e: PRJ

) Body

~O

l~:, Ul llg

the

CtTl ificCite

(11<:l\ne and address )

~)2234 '5 ~24 S9

II BZ Z IIO LL[

NH HFRI A"D S

.J. Selle r of Ih l: product {name and adJ ro '> I

4. 11r'lh:ction body"\<

Kopl' ra si Perl H;'"! I;} Gayo

JI SYldh Ulan13. No. 66 Kalllpun E Simpang Utalll3, Pond ok Ba ru
2 4:'i~2 Bener \l eflCl h

ContfQIl'lli on Certific ations B.\!.

I\ ct h

NETHERLANDS

(na1l1~

and address)

Meeuwenlaan 4-6
BZ ZWOLLE

~Oll

INDONESIA

6, Country OJ dispatch
INDONESIA

5. Producer or processor of the product" (name and address)

Koperasi Permsta Gayo (Bromo Ujll ng)
JI. Bromo Ujllng. Gang Ikhlas No. 2Medan
Surnatera Ut ilra

INDONESIA

x. Country of destination

7. Consignee (name and address)

UN IT ED STA TF,

Cooperative Coff'ees Inc.

302 Lamar Street Suite E
Gi\ 31709 Americus
UNITED STA r'ES
10. Marks and num her, . container

9, Adrlre:,s and place (I f destination'"

1l0{s). nu mb!.,; !"

and kind. Trade name or the product

100% organic Sumatra Pennata C;ayo Arab ic-a Coffee (Sumatra Permata Gayo
Higll la nd Arabica DP ~ ra dc 1 Grl'l.'l1 Coffee FLO- Fa irt r;lde and Orga ni c Ce rt ified )
p 3c ~ed in

II Gross

Production
Year

NOP L" cnillcd

Lot il)3tch
numbers

]015

Gro:-.s mass Net mas:o,

(kgs)
(kgs)

17080.00

16800.00

Uni t 60 kg" In lXO Kgs

nid:-"'

17080.00

11. I\.:t

,,~,

ill ,ISS

16800.00 k~,

["rom organic productlon methods

Invoi ce 110.. 025/INV/ PGCi20 1.5 ~ O 16 d.d. 25-02-1 ()

13. Alternative units ;"

Transport document 00 .. (j IGL IV 16UOO I 0 c.d. 28 ..02.. 16

Container no .. J'v1ED 03 55369-X

Identi fication codes Penn ata Gayo Coo p Ick:ll titl cation Code:O 15 ' 1730125 SUG-167 Seal NoFE J739l:l659 Sh lpplllg Company TrJ
nsGlobal
14. Declaration of the body issuing the certificate:
15. Additio lla l declaration (if appropriate)
This Product is "Certified in Compliance \vllh the terms of the US-Canada Equivalency Arrangelllcm"
Jakarta. 04 March 2016
)6. PlaCe and elate of issue
~a me and signature of authorised person

O~bC h U! f of M

I f

Stam p of tlie

i S~ lI ing

body

gi nb Director

'~m,~

\ l a-;Y~ r()
c-m..~~ .

~~~"'r".wQd
! ..... ~-"""~

"'Explanatory notes

Box 4: The ins pection and certi ficat ion hody for compliance with the rules on from organic rroducU0n meth ud .....

Box 5: Tht.' firm wh id l carri ed out the last operation (prOces:':!llg, pack ag ing, labe Uin.g ) on the hatc h.

Box 9: The address of the finn where [h..: bat..:h will be delivl:rcd. lf different from the add ress in box 7

Box 13: e,g. yolum ~ l l1 meters. \0 be gi ven. \\ here appropriate, in sup plement 10 th e J ecl arauons in boxes II Jnd J 2.

TRANSACTlO:\ CERTIFICATE

USA FOR PRODUCTS FROM NOP ORGANIC PRODUCTION

I lJo ciy

is~u11lg

2 al The Nati onal Organic Progmm standards orlhe United States Department of
Agm:uh un. ..'Co lllrol li nion C ena fi(:a li o n ~ ..,trtl1dards
2 b) Itc f~ ;~ n ce number orIhe certifi ca te : PRJ ~ 1 2234 ' 5 ~2 4 65

the certifica te (n ame and ad ci re':l::' )

Control Union Certific,'l(i oll s B.V.

\ 'lee uwen laan 4-6
~O l l

BZ ZWOLLE

~ETHE RLAN D S

J. Seller ur lhe prod uct (n ame and alld ress)

4. In spec tio n body {name an d address)

Kopera:si Pe nnata Gayo

JI. Syiah Ula ma. No. 66 Kal11 pulIg 511n pa ng Ula ma, Pondok Bam
24582 Bene r N1e ri a h

Contro l Uni on Ce rtifi cati ons B.V.

Aceh

Mecuweniaan 4-6
SUI I BZ ZWO LLE
NET HERL,\ NDS

INDON ES IA

5. Producer or processo r of the product " (name and address )

Ko peras i Permata Gayo (Bromo Uj un g)
.II . Bromo Ujung, Gang Ikhlas No. 2M eda n
Sumatera Utara
INDONESIA

H. COU ll try ofdt!s til lal lo n

ll NiTED STATES

7. Co nsignee (name and address )

Cooperati ve Coffees Inc.
302 Lama r St reet Suite E
GA 3 1709 Americ us
UNIT ED STATES
10.

~'1a rk s

9.

Addn:~':)

a nd pla..:c uf oC5ti nali o n*

II. Gro:iS

and numbers. co ntainer II O(S). number and kin d. Trade name of the produc l.

Prod ucl lon

Yea r

NOP rti"ed
100% organ ic Sumatr a Pen1lata Ga)'o Arabica Co ffi;.'c (Sumatra Pennata Gayo
Hig hl and A ra bicd Spec ialty Grad e-l Green Coffee f LO-Falrtrade and Organic
Cer l jfi~d)

6. Coun try of dispa tch

IN DO NES IA

packe d in Unit 60

k:;~ In

Lotfba tch

Gross ma ss Nel mass

numbers

(kgs)

244 0.00

2U I5

(k gs)

2400.00

40 Kgs

m 3$S

2440.00 kgs

12. Ne! mass

24UO.UO kgs

fro m orga nic production method".

lil vo ice no. 02611 NV/PGCl20) 5/20) 6 d.d. 25-02- 16
rra n ~port documenL no.: GIBL W 16000 I 0 d.d . 2~ - 02- t 6

) 3. A lta n311 ve un i!s ..

Con tainer no .. M EDUJj:"J69-X

Identifica ti on. codes: PemJata Ga yo Coop Ide nt ifica tion Codc:O 151173 0/26 SUT-) 62 Seal NoFEJ7398659 Shipping Company

rrn llsG lob I

"

t4. Declarat ion of the body iss uin g Ihe certi ri cate
)5. Add HlonJI declarati on (if app rupriale)
Th is PrQCllctls "Certifi ed in Comp liance with lhe lerms of the US-Canada Equiva lency Arrangement "

16. Place and date of i s~u e

Ja karta. 04 l'vlarch 2016
Name and signature of authorised perso n

S!a1l1p

the

() f

i!oo~ u i n g

hody

;~;;:l;;l~;;t{ D"~fuc
\\' 1

'I~~:,:orh. M~. (J
("'
r

* E~I')llllal\)ry nOles

Box 4 : Th e: Ills pection and ce n iri ca lion body fo r comp liance wi th the rules on fro rn organic proJ uctlon methods

Bo;o; 5 . The linn which ea rned oUllhe lasl opt:rali oo (processing. pac kag lllg. iahdli ng) 0 0 Ihe balch.

Box 9' The adc rL';;s Of lhc flfln where lhe balch will be deli vered. if di l)"e rt.'11 1 from Ihe address in b x 7.

Box 13: e.g. vo lume in melers. (0 be g.iven. where appropnate. in supplement 10 the declarations In boxes I I Jnd 12.

c:-.UrMr~ .

IQO. . . . . .,. ... l.ItIIIR

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