Organic Program 2017 Farm Crop Renewal Application

Organic Program 2017 Farm Crop Renewal Application Farm or Business Name: Applicant Name: Title: Phone: Email: Preferred Contact: Email Phone Contact Name: Title: Phone: Email: Preferred Contact: Email Phone Additional Contact: Title: Phone: Email: Preferred Contact: Email Phone Mailing Address: City: County: State: Zip Code: Preferred method of correspondence including certification and notices: Mail Email Please provide the physical address/location of the farm, with detailed directions from Albuquerque, NM to the site: Business Information: Please provide information detailing the structure of your business (ownership, legal entity status, etc.): 2016 Gross Sales: 2017 Estimated Gross Sales: Please note, this form is meant to act as an update to your operation s already agreed upon and certified Organic System Plan. If your operation is not already certified organic by NMDA, please fill out the full Organic System Plan available on our website. Information detailed in this document should fully detail any changes that have been made based on the last time you corresponded with NMDA. Failure to fully disclose changes may result in a Non-compliance. Page 1 of 12

Affirmation of Organic Applicant I,, as an authorized representative of [Business Name], depose and say that I will: 1. Fully comply with all applicable organic production and handling regulations in accordance with Title 7 CFR Part 205 National Organic Program Rule. 2. Establish, implement and update annually an organic production or handling system plan that will be submitted to the New Mexico Department of Agriculture (NMDA). 3. Supply NMDA with all information required to verify compliance with the National Organic Program Rule. 4. Permit onsite inspections with complete access to the production or handling operation, including non-certified production and handling areas, structures, and offices by NMDA inspectors. These inspections may be announced or unannounced at the discretion of NMDA or as required by the Administrator of the National Organic Program. 5. Maintain all records applicable to the organic operation for not less than five (5) years beyond their creation. 6. Allow authorized representatives of NMDA, or the US Secretary of Agriculture access to these records during normal business hours for review and copying to determine compliance with the National Organic Program Rule. 7. Submit to NMDA the applicable fees as described on the fee schedule which is current at the time of payment (see page 11). 8. Immediately notify NMDA about any application, including drift, of a prohibited substance to any field, production unit, site, facility, livestock, or part of an operation. 9. Immediately notify NMDA of any change in our certified operation or portion of it that may affect its compliance with the National Organic Program Rule, including: additions or deletions of crops & fields; new inputs (fertilizers, pest control processing aids, etc.); facilities; ingredients & products; changes to managers; responsible parties; contact information or email address. 10. Understand that willful violation of organic rules and regulations may result in revoking of organic certification, and in extreme cases may lead to state and federal fines and penalties. 11. Understand that submitting this application in no way implies granting of certification by NMDA. 12. Understand that this form becomes a legally binding document upon submission by NMDA. Print Name: Title: Signature of Authorized Representative: Date: Page 2 of 12

Section 1. General Information 7 C.F.R. 205.201, 205.401 1. Are you currently certified by NMDA? Yes No 1a. If No, please fill out and submit the full OSP for new applicants. 1b. If Yes, how long have you been certified by NMDA? 1c. If Yes, please list any issues noted or information requested by NMDA in the last twelve months: 2. Submit a Map that: Map Attached o Matches your Field History. o Includes every organic farm/field. o Shows farm name, field name and acreage of each field. o Shows borders & shape of each field. o Identifies location of crops and fallow land. o Accurately shows land boundaries and organic buffer zones. o Identifies all adjacent land use, such as other farms, roads, ditches, open range, etc. o Indicates NORTH. 2a. Are you requesting the addition of any New Fields in 2017? Yes No If Yes, please include detailed maps for each new field that is requested for addition in 2017 (submit electronic or paper attachments). New Field Map Attached 2b. Have you constructed any new buildings or structures (hoop houses, cold storage, etc.) since the time of your last inspection? Yes No If Yes, please include the new structure in submitted maps. If Yes, please list materials used in the construction of the structure: 3. Neighboring Land Use: Please describe any changes to neighboring land use that have occurred since the time of your last inspection: Page 3 of 12

4. Field History: For fields certified organic by NMDA in 2016, please complete the following table: Farm/Field ID: Farm name and unique field identifier (name or number). Location: Township, Range, Section or Physical Address of field. Input: Any material input applied to fields (disease control, pest control, fertility). If more space is needed, please include attachment Field History Attached Farm/ Field ID & Location Acres 2017 Crops 2017 Inputs 2016 Crops 2016 Inputs 4a. Are you requesting the addition of New Fields not previously certified by NMDA? Yes No If Yes, please submit a New Field History Form and submit with your application. New Field History Form Attached 5. Crops Requested for Certification in 2017: Please provide a complete list of crops you want to certify in 2017 (submit electronic or paper attachment). This will be used to prepare your Organic Product List. Please list generic crops and NOT variety (examples: wheat, tomato, basil, apples, etc.). You may not sell new products (products not certified organic in 2016) as organic until they appear on your 2017 Organic Product List. 2017 Crop List Attached Page 4 of 12

6. Please submit all current Custom Service Compliance Statements for contract custom services provided during handling, or storage of organic crops. 7. Do you label any products? Yes No 10a. If Yes, please submit label proofs to NMDA for approval before printing. (NMDA is NOT responsible for liable for non-compliant or incorrect labels.) All Proposed Labels Attached Section 2. Material Inventory 7 C.F.R. 205.201 Please list all materials currently in your material inventory and also all materials that you are requesting to add in 2017. Please include brand name of the product. Please note: seed, seed inoculants, seed coating, etc. will be requested in the Seed section of the application and should not be placed in this section. If more space is needed to detail Materials please submit a separate attachment (electronic or paper). Additional Material Inventory Attached Material & Brand Name (please be specific) Purpose New in 2017 1. Micronutrients: The use of Micronutrients must be justified by soil or tissue testing or other analysis. 1a. Do you apply micronutrients to manage for deficiencies? (Iron, zinc, etc.) Yes No o If Yes, please maintain justifiable micronutrient deficiency analysis in your records. Page 5 of 12

Section 3. Seeds, Annual Transplants, & Seedlings 7 C.F.R. 205.204 N/A: No seeds, planting stock, or annual transplants are used. Skip to Section 4. 1. Seed Source: Have you changed seed or planting stock sources in 2017? Yes No 1a. If Yes, please list all current seed and planting stock sources: 2. Non-Organic Seed: Will you use non-organic seed or planting stock in 2017? Yes No 2a. If Yes, please include an Organic Seed Search and also Non-GM and Untreated seed documentation with your application. 3. Saved Seed: Have you in the past or do you plan in the future to save your own seed? Yes No 3a. If Yes, please be advised, saved seed records detailing variety, quantity and year produced must be maintained and will be verified at the time of inspection. 4. Perennials: Are you adding new perennials in 2017? Yes No 4a. If Yes, please list varieties, organic status, and supplier: N/A: No annual transplants are used. Skip to Section 4. 5. Annual Transplants: Will your supplier or production of annual transplants change from previous years, in 2017. Yes No 5a. If Yes, please detail any changes regarding annual transplants below: Page 6 of 12

Section 4. Soil Fertility & Crop Nutrient Management 7 C.F.R. 205.200, 205.203, 205.205 1. Management Practices: Have your soil fertility and/or crop nutrient management practices changed in 2017? Yes No 1a. If Yes, please describe, in detail: 2. Manure & Compost: Has your use of raw manure or compost changed in 2017? Yes No 2a. If Yes, please describe, in detail: 3. How do you determine the effectiveness of your soil fertility practices? 4. Can your material application records track all fertility inputs applied to organic fields? Yes No Section 5. Crop Rotation 7 C.F.R. 205.205 1. Crop Rotation Plan: Has your crop rotation plan changed in 2017? Yes No 1a. If Yes, please describe: Section 6. Natural Resources: Soil, Water, Woodlands, Wetlands, & Wildlife 7 C.F.R. 205.200 1. Natural Resources: Has your natural resource management plan changed in 2017? Yes No 1a. If Yes, please describe: Page 7 of 12

Section 7. Water 7 C.F.R. 205.200 1. Water: Have your water sources changed in 2017? Yes No 1a. If Yes, please list changes: 2. Fertigation: Has your application of fertilizers through an irrigation system changed? Yes No 2a. If Yes, please describe: Section 8. Weed, Pest, & Disease Management Practices 7 C.F.R. 205.206, 202.600-602, 205.103 1. Input Records: Can your material application records track all inputs applied to certified organic fields? (Including all inputs for weed, insect pest and disease management?) Yes No 2. Monitoring: Have your methods for monitoring weeds, insect pests and diseases changed in 2017? 2a. If Yes, please describe: Yes No 3. How do you determine the effectiveness of your weed, insect pest and disease management practices? Section 9. Split & Parallel Production 7 C.F.R. 205.272 1. Do you produce organic and non-organic crops? Yes No 1a. If Yes, please attach a complete list of all non-organic fields and also, all non-organic crops produced. Page 8 of 12

1b. If Yes, please list any changes to your plan to prevent contamination and commingling in 2017. Section 10. Harvest, Packing, Storage, & Transportation 7 C.F.R. 205.272 1. Harvest: Have your harvest practices changed? Yes No 1a. If Yes, please list and describe all changes: 2. Post-Harvest: Have your post-harvest processes changed? Yes No 2a. If Yes, please list and describe all changes: 3. Storage: Has your use of onsite and offsite storage changed? Yes No 3a. If Yes, please list and describe all storage locations planned for use in 2017. Section 11. Recordkeeping 7 C.F.R. 205.103, 205.201, 205.205 Organic producers are required to maintain records concerning the production, harvesting and handling of organic crops, organic livestock, and organic livestock products. These records must fully disclose all activities and transactions of the operation in sufficient detail to be readily understandable and auditable and must be available for inspection and copying. Records must be maintained for 5 years. 1. Records: Please list and describe, in detail, all records that you maintain pertaining to the production, harvesting, handling and sale of organic crops and products: Page 9 of 12

2. Do these records fully disclose all activities and transactions of your operation in sufficient detail? Yes No 3. Can your recordkeeping system balance crops harvested with crops sold? Yes No 2016 Sales Information Please provide detailed information for sales of organic crops and products in 2016. Please be as thorough as possible as this information will be verified at the time of your next inspection. Organic Crop/Product Yield (pounds, tons, bushels, etc.) Wholesale Sales (round to the nearest dollar) Direct to Consumer Sales Farmers On-farm Sales Markets CSA Sales Total Certified Organic Sales 2016 Page 10 of 12

NMDA Organic Program Fee Schedule Fee Schedule The Assessment Fee is three-fourths one percent (3/4 percent or.0075) of the first million dollars of gross organic sales, plus seventy-five one thousandths of one percent (.00075) of the gross organic sales over one million dollars. Assessment Fee Total Gross Certified Organic Sales for the 2016 Calendar Year (Jan. 1, 2016 Dec. 31, 2016, Please round figure to the nearest dollar) Sales between $0 - $1,000,000 $ $ Example= $1,200,000 Multiply by 0.0075 =$ Sales above $1,000,000 $ Ex. = $1,000,000 Ex. = 1,000,000 x 0.0075 Multiply by 0.00075 Ex. = $7,500 =$ Ex. = $200,000 Ex. = $200,000 x 0.00075 Total Assessment Fee = $ Ex. = $7,650 Ex. = $150 Application Fee NEW Applicant Fee RENEWAL Applicant Fee Not Certified Organic by NMDA in 2016 Previously Certified Organic by NMDA in 2016 Application Fee = $250.00 Renewal Fee = $200.00 Application Fee = $ Late Fee (for RENEWAL applications postmarked after April 1, 2017) Renewals received after April 1, 2017 Late Fee: $75.00 Renewals received after May 1, 2017 Late Fee: $100.00 Renewals received after June 1, 2017 Late Fee: $200.00 Renewals received after July 1, 2017 Late Fee: $500.00 Late Fee = $ (Total Assessment Fee + Application Fee + Late Fee) = Total Fees = $ Business Name: Authorized Representative Signature: Date: Page 11 of 12

NMDA Organic Program Fee Schedule Fee Policy 1). Fees are NOT REFUNDABLE 2). Make checks Payable to NMDA 3). If new or additional fields or products are added after the annual inspection is complete, additional costs will be incurred. A cost estimate will be provided. o If a second inspection is necessary you will be billed for the actual cost of the inspection and the actual cost of the office audit ($40/hr) to complete the addition. o In cases where no second inspection is required, you will be billed for the actual cost of the desk audit ($40/hr). o Payment must be received before the new or additional fields/products are certified organic and added to the Organic Product List and the Organic System Plan. Mailing Procedure Please mail Application, Payment and Cost Share documents to: NMDA Organic Program 2604 Aztec Rd NE Albuquerque NM 87107 Or email application to certifier@nmda.nmsu.edu Cost Share Please complete the following pages in order to receive Cost Share Reimbursement. Page 12 of 12

NMDA Organic Program Fee Schedule Application for Cost-Share Reimbursement 2017 Name of Certified Organic Business: Your Name: Type of Certification (crop, livestock, processor): Address: City: State: Zip: Phone: Fax: Email: Name of your certifier (NMDA, etc.): Allowed reimbursement costs for certification include: application fees, inspection fees, user fees, postage and assessments. Late fees and charges relating to violations of the organic standards are not eligible expenses. If you have questions about a particular expense, please call (575) 646-2752. If you are certified by NMDA you do not need to attach receipts unless you are claiming postage. If you are claiming postage or are not certified by NMDA you must attach receipts. Everyone must attach an itemized list of items to be reimbursed. A) During the year10/1/16-9/30/17 I spent (the following amount) $ on organic certification expenses. B) Multiply the amount above x.75. $ C) If the number on line B is larger than $750 you are eligible for a reimbursement of $750. If the number on line B is less than $750, that amount will be the amount of your reimbursement. D) If you were first certified in 2017, or are certified by a body other than NMDA, please attach a copy of your certificate. This is REQUIRED! TOTAL REIMBURSMENT: I, understand that under the NOP cost-share program I am eligible to apply for 75% of my annual certification costs up to $750/year for Federal FY 2017, and nothing more. Awards of funds will be made on a first-come first-served basis (of the complete application); funds may not be available to reimburse every certified business. Date: (sign here) Please follow the instructions on the next page.

NMDA Organic Program Fee Schedule Please follow these instructions. 1. The Organic Cost-Share Program is a federal program, funded by the 2014 Farm Bill, to reimburse producers and processors for 75% of the cost of organic certification, up to $750. You must apply to receive reimbursement. If you have more than one certification (e.g. crop and processor) you may apply for EACH current certificate, but you must complete a separate application for each certified operation. 2. In New Mexico, the New Mexico Department of Agriculture is the agency responsible for distributing the federal funds. All certified organic New Mexico businesses are eligible for reimbursement as long as they have successfully completed the certification process and have a current certificate from a USDA-accredited certifier. 3. You must fill out the forms completely and include the required attachments to be reimbursed. 4. Requests for reimbursement must be received no later than 10/31/17. 5. There is no guarantee that funds will be available. Reimbursements will be issued on a first-come-first served basis until the money runs out. 6. What is important in figuring your certification costs for a particular year is the date that you wrote the check to cover those costs. Checks you wrote from 10/1/16-9/30/17 would be eligible for cost share reimbursement this year. Your certification year, (the date on your certificate or renewal) is irrelevant to this program. Eligible expenses generally are ones for which you paid your certifier. Application fees and assessments are eligible. Late fees charged for late application submission are not eligible. 7. Please don t hesitate to call Elaine Padilla at (575) 646-2752 if you have any questions about this program. We want you to get your reimbursement. What you have to do Guided by the information above: 1) Fill out the cost-share application and sign it. 2) Fill out the NMSU Vendor Questionnaire form. Section 1, Are you currently working with a department on a purchase-although you are NOT actually working on a purchase, Check Yes, and write in "NMDA". Section 2, Check your Business Type. Section 3, Do Not select "One-Time Payment", as this will remove you from the system as soon as payment is made to you. If you file as an individual, sole proprietor or any type of LLC, you MUST complete Section 5: Independent Contractor Determination. For Question 2 of this section, please write the following: I am not providing a service to NMSU but am being reimbursed for fees paid to NMDA. Print, Sign and Date the form on page 4. 3) Include a copy of your current organic certificate if you were first certified in 2017, or are not certified by NMDA. 4) Include an itemized statement of certification expenses; and, if not certified by NMDA or you are claiming postage, please attach receipts. 5) Please confirm that the Vendor Questionnaire is complete and all questions answered. 6) Do NOT Send the VQ (Or any other documents) to NMSU. Send ALL the above items to: Julia Conlogue NMDA Organic Program 2604 Aztec NE Albuquerque, NM 87107 2017 Vendor-Questionnai