PECONIC LAND TRUST 1 NYS Grown & Certified Agricultural Producers Grant Application Please Note: The information shared through this application will not, under any circumstances, be shared with anyone other than staff from GrowNYC, HMRCD, HVADC, Peconic Land Trust or the New York State Department of Agriculture and markets. We are required by our grant funder to collect the information below. Applicant Information Name: County: Legal Name of Farm Operation/Applicant: Name of Person Authorized to Apply on Behalf of Operation: Street Address of Farm Operation/Applicant: City: State: Mailing Address (if differs from Physical: Email: Phone: Zip: Federal Taxpayer ID: Tax Map #: DEC Permit #: (shellfish operations) Are you eligible? (Yes/No): Yes No The farm operation is located wholly within New York State and produces an agricultural product as defined by the New York State Grown and Certified program guidelines. (See https://certified.ny.gov/get-certified for Program Guidelines) Are there any owners who DO NOT participate in the day-to- day production of an agricultural product grown or raised on the farm operation? Is the applicant or any owner presently the subject of any litigation or is litigation threatened which will likely have a material adverse effect on the applicant’s financial condition? Attestations (Yes/No): Has the applicant/owner(s) been or is the applicant/owner(s) involved in bankruptcy, a creditor’s rights or receivership proceeding, or sought protection from creditors?
15
Embed
THE SEALS - GrowNYCPANTONE Process Cyan CMYK 100/0/0/0 RGB 0/174/239 HEX# 00AEEF PANTONE Cool Grey 10 CMYK 40/30/20/66 RGB 71/76/85 HEX# 474C55 JUNE 2017 TYPOGRAPHY Proxima Nova is
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Are there any owners who DO NOTparticipateintheday-to-dayproductionofanagriculturalproductgrownorraisedonthefarmoperation?
Istheapplicantoranyownerpresentlythesubjectofanylitigationorislitigationthreatenedwhichwilllikelyhavea material adverseeffectontheapplicant’sfinancial condition?
Proxima Nova is used on all collateral related to the
NYSGC programs. Headlines may be set in uppercase
Proxima Nova Bold, and subheads may be a mix of
uppercase and lowercase Regular, SemiBold, and Bold,
depending on individual needs. Proxima Nova can be
purchased from myfonts.com.
Proxima Nova RegularProxima Nova Regular ItalicProxima Nova SemiBoldProxima Nova SemiBold ItalicProxima Nova BoldProxima Nova Bold Italic
2
Attestationscont. (Yes/No)Has theapplicant or any owner settled adebt with alendinginstitutionfor less thanthe full amount outstanding withinthelast3years?
Yes No
Has theapplicant or any owner ever been convicted of anyfelonyormisdemeanor,otherthanaminortrafficviolation,or are any suchcharges pending?Has theapplicant or any owner ever beenout of compliancewithfederal, state or local laws or regulations withrespect tolabor practices, hazardous wastes, environmental pollution oroperating practices?Are there any outstanding judgments or liens pending againstthe applicant or owner other thanliens inthe normal courseof business?Are there any outstanding judgments or liens pending againstthe applicant or owner other thanliens inthe normal courseof business?Has theapplicant or any owner ever defaulted on anobligationtothe New York State UrbanDevelopmentCorporation, doing business as Empire State Development(ESD) or any other agency or public benefit corporation of theStateof New York?Ifafarmowner’sspouseisnotidentifiedasanownerofthefarm operation in Section 5C(1) of theapplication, has thespouse hadanownershipinterest inany farm operationsinceApril 1, 2007?IF YOU ANSWERED“NO” TOTHE ABOVE QUESTIONS,PROCEED WITH THEFULL APPLICATIONIf youanswered “YES” toany of theabovequestions provideadetailedexplanation on theattachedsheet and submit it witha complete application. Your applicationwill be reviewed, howeverprogram eligibility cannot beguaranteed.
Proxima Nova is used on all collateral related to the
NYSGC programs. Headlines may be set in uppercase
Proxima Nova Bold, and subheads may be a mix of
uppercase and lowercase Regular, SemiBold, and Bold,
depending on individual needs. Proxima Nova can be
purchased from myfonts.com.
Proxima Nova RegularProxima Nova Regular ItalicProxima Nova SemiBoldProxima Nova SemiBold ItalicProxima Nova BoldProxima Nova Bold Italic
5
Project Description – addadditional pages as necessaryBriefly describe the proposedproject:
How will this project fulfill thefood safety requirements of theNYS Grown & Certified Program?
IfyouareacurrentGrown&Certifiedparticipant,explainwhythisprojectisnecessarytomaintainthe foodsafety requirements of the program, significantly improve foodsafety practices, or how itwill enable additional producers tomeet the foodsafety requirements of the program:
What opportunities will this capital investment create andwhat kindof economicimpactwillthisinvestment haveon your operation (e.g. expanded market opportunities, job creation/retention,etc.)?
Proxima Nova is used on all collateral related to the
NYSGC programs. Headlines may be set in uppercase
Proxima Nova Bold, and subheads may be a mix of
uppercase and lowercase Regular, SemiBold, and Bold,
depending on individual needs. Proxima Nova can be
purchased from myfonts.com.
Proxima Nova RegularProxima Nova Regular ItalicProxima Nova SemiBoldProxima Nova SemiBold ItalicProxima Nova BoldProxima Nova Bold Italic
6
What are the biggest challenges youforesee incompleting your project?
What are the biggest challenges youforesee inmaintaining your New York State GrownandCertifiedcertification over thenext 5 years?
Why doyouwant tobecome New York State GrownandCertified?5
Project Description – addadditional pages as necessaryBriefly describe the proposedproject:
How will this project fulfill thefood safety requirements of theNYS Grown & Certified Program?
IfyouareacurrentGrown&Certifiedparticipant,explainwhythisprojectisnecessarytomaintainthe foodsafety requirements of the program, significantly improve foodsafety practices, or how itwill enable additional producers tomeet the foodsafety requirements of the program:
What opportunities will this capital investment create andwhat kindof economicimpactwillthisinvestment haveon your operation (e.g. expanded market opportunities, job creation/retention,etc.)?
Product Specific Requirements:Below are product specific requirements of the NYS Grown& Certifiedprogram forvariouscommodities. Pleasereview and check alloftheproductsthatyouwillbecertifyingundertheNYSG&Cprogram andmark “Yes” or “No” onwhether youcurrently meet eachindividual product requirement.
□ Produce:
☐Yes ☐ No:NYRequirement: Labeledproduce is growninNew York State.☐Yes ☐ No:(Yes/No):Food Safety: AnnualUSDAGAP/GHPorsimilarthirdpartyfoodsafetyaudit(AIS, Primus etc.) for at least onecrop field and handlingprocess. ☐Yes ☐ No:Environmental:Participationin New York State Agricultural Environmental Management (AEM) program, administeredby the Department of Agriculture andMarkets, withthe completionof Tier 2 of the program (or higher)withinthe past three years.
FSMACompliance:☐Yes ☐ No: Your company’s combined annual Direct-To-Consumer revenue (farmer’smarkets,pick-your-own, farmstand, restaurants, etc), less than $500,000.☐Yes ☐ No: Themajorityofyourfarm’ssalestoconsumers,restaurantsorretailersinNYStateorwithin275milesofyourfarm.
GAPsCertification:
(Applicants seekingGAP/GHPcertificationmust first contact the Ag& Markets GAPCertificationProgram - Rochesterand Western NY: 585-427-0200;Albany andEasternNY: 518-457-2090):
Please select the level of foodsafety compliance establishedonyour farm currently:□ CompletedandPassedOn-Farm GAPaudit□ CompletedandPassedDesk GAP audit□ Implemented a working Farm Food Safety Plan with 3months of completed logs□ Designed aFarm Food Safety Plan□ Attendeda GAP training course□ None of the above
Ifyouhave passeda GAP audit, whichstandardof GAP compliance didyouchoose□ USDA□ GlobalGAP□ SQF□ Primus□ Other_________________________________________________________
Yes Annualthirdpartyfoodsafetyaudit(SQF,orsimilar).Safefoodhandlingtrainingcourse(only for onfarmprocessors).ProcessorPlantSupervisorTraining(PPS).
Food Safety:
Environmental:
10
□ Dairy:☐Yes ☐ No:NYRequirement: MajorityofmilksupplyisfromNewYorkState,processorislocatedinNYS☐Yes ☐ No: Food Safety: Annualthirdpartyfoodsafetyaudit(SQF,orsimilar).☐Yes ☐ No: Safe foodhandling training course (onfarm processors).☐Yes ☐ No: Processor Plant Supervisor Training (PPS).☐Yes ☐ No: CleanAg & Markets inspectionrecordfor 1 year prior toapplication.☐Yes ☐ No: Environmental: Producer or majority of producers participatedincounty Soil andWaterAgriculturalEnvironmental Management Program (AEM) at Tier 2level OR has aCAFO permit.
□ Shellfish:NYRequirement:☐Yes ☐ No: Labeledoysters are growninNew York State.☐Yes ☐ No: Seed may bepurchased out-of- state,accordingtoDECguidelines(northofNY).☐Yes ☐ No: State, county or municipality, or private Aquaculture Lease.Food Safety:☐Yes ☐ No: NYSDECShellfishDigger/Dealer/ShipperPermitsasapplicable.Hazard☐Yes ☐ No: AnalysisandCriticalControlPoint(HACCP)Plan,ifapplicable.☐Yes ☐ No: Adhere toVibrioparahaemolyticus (Vp) Control Plan.☐Yes ☐ No: HACCP trainingcourse, if applicable.☐Yes ☐ No: Digger andDealer Education Course(every 5 years.)Environmental:☐Yes ☐ No: On/Off bottom Culture Permit NYSDEC.
□ Eggs:NYRequirement:☐Yes ☐ No: Labeledeggs are from New York State hensFood Safety:Farms with >3,000hens:☐Yes ☐ No: ParticipationinFDA’s Salmonella Surveillance Program/ Preventionof SalmonellaEnteritis☐Yes ☐ No: Vaccinationprogram toprotect birds and eggsagainst S. enteritis.Farms <3,000hens:☐Yes ☐ No: Annual Salmonella testing program (throughAg&Markets or veterinarian)☐Yes ☐ No: National Poultry Improvement Plan(NPIP), US Pullorum-Typhoid Clean Status.☐Yes ☐ No: Farms with offsite Packing houses:☐Yes ☐ No: Third party food safety/safe egg handling audit program.Environmental:☐Yes ☐ No: Producer or majority of producers participate inNewYorkStateAgriculturalEnvironmental Management (AEM) program, administered by the DepartmentofAgriculture andMarkets,withthecompletionofTier2oftheprogram(orhigher)withinthepastthreeyearsORhasaCAFO permit.
NYRequirement:
YesYes
Yes
NoNo No
Shellfish
Clean Ag & Markets inspection record for 1 year prior to application.
Producer or majority of producers participated in county Soil and Water Agricultural Environmental Management Program (AEM) at Tier 2 level or has a CAFO permit.
NYRequirement:
Environmental:
Food Safety:
Labeled oysters are grown in New York State
No
Yes
No
Yes No
Yes No Yes No Yes No Yes NoYes NoYes NoYes NoYes NoYes No
NYSDEC permit: Class A - Shellfish shipperNYSDEC permit: Class B - Shellfish processorNYSDEC permit: Class C - Shellfish re-shipperNYSDEC permit: Class D - Shellfish digger/shipperNYSDEC permit: Class E - Bay Scallop shucker/packerHACCP Training Certificate (shippers/dealers), if applicableAttestation of written HACCP plan, if required by your permit.Attestation of a written control plan, if required by NYSDEC permit.Importation Permit (if seed is obtained from another state)
Yes NoYes No
NYSDEC On/Off Bottom Culture Permit. Please provide copyState, County, Township, or Private Lease of underwater beds; Deed for privately ownedunderwater rights
□ Beef:NYRequirement:☐Yes ☐ No: Animalspends2/3oflifeinNewYorkState.Food Safety:☐Yes ☐ No: Animals are slaughtered/processedina USDAInspectedSlaughter Plant.☐Yes ☐ No: Participationina herdmanagement program, suchas NY Beef Quality Assuranceprogram at Tier 2 level.☐Yes ☐ No: Animalsmusthaveofficialidentificationpriortoslaughter (RFID preferred.)Environmental:☐Yes ☐ No: Producer or majority of producers participate intheNewYorkStateAgriculturalEnvironmental Management (AEM) program, administered by the Department of Agriculture andMarkets,withthecompletionofTier 2of theprogram (or higher) within thepast threeyears OR has aCAFO permit.
□ Poultry:NYRequirement:☐Yes ☐ No: Chicks brought toNY within1 week of birth.Food Safety:☐Yes ☐ No: AnimalsareslaughteredinaUSDAInspectedSlaughterPlantor a5-AStatePlant.Environmental:☐Yes ☐ No: Producer or majority of producers participate intheNewYorkStateAgriculturalEnvironmental Management (AEM) program, administered by the Department of Agriculture andMarkets,withthecompletionofTier2oftheprogram(orhigher)withinthepastthreeyearsORhasaCAFO permit.
□ Pork:NYRequirements:☐Yes ☐ No: Animalspends2/3oflifeinNewYorkState.Food Safety:☐Yes ☐ No: Animals are slaughtered/processed in aUSDA Inspected Slaughter Plant.☐Yes ☐ No: Participationinathird-party management program, suchas the Pork Quality Assurance-Plus program.☐Yes ☐ No: AnimalssoldormovedfromfarmmusthaveofficialID.Environmental:☐Yes ☐ No: Producer or majority of producers participatein theNewYorkStateAgriculturalEnvironmental Management (AEM) program, administered by the Department of Agriculture andMarkets,withthecompletionofTier2oftheprogram(orhigher)withinthepastthreeyearsORhasaCAFO permit.
□ Maple:NYRequirement:☐Yes ☐ No: Syrup is sourced from New York mapletrees and processed in New York State. Whensyrupof a desiredgrade is not available as required, upto25% may be sourcedfrom out-of-state.Food Safety:☐Yes ☐ No: Certificate of completionof Cornell Cooperative Extension’s Maple FoodSafety Class and
12
Producer participates inone of the following environmental management programs, or equivalent:☐Yes ☐ No: » New York StateAgricultural Environmental Management (AEM) program, administeredby the Department of Agriculture andMarkets, withthe completionof Tier 2 of the program (or higher)withinthree years of admissionintothe New York State Grown& Certifiedprogram;☐Yes ☐ No: » Certified TreeFarmer, administered by theAmerican TreeFarm System;☐Yes ☐ No: » SustainableForestry Initiative(SFI) Certified Chain of Custody; or☐Yes ☐ No: » Forest Stewardship Council (FSC) Forest Management Certification
□ Cut Flowers:NYRequirement:☐Yes ☐ No: Labeledflowers are growninNew York State.Environmental:☐Yes ☐ No: Participationinthe New York State Agricultural Environmental Management (AEM)program, administeredby the Department of Agriculture andMarkets,withthecompletionofTier2oftheprogram(orhigher)withinthepastthreeyears.
□ Beer:NYRequirement:☐Yes ☐ No: Minimum60%hops,malts,andgrains(byvolume)growninNewYork.☐Yes ☐ No: 100%ofNewYorkhops,malts,andgrainsmustbe from NYS Grown & Certified farms.Food Safety:☐Yes ☐ No: Beveragemanufacturers must havea20-CORfarm brewery license. Any inspectionrelatedissues must be resolvedwithin30 days.Environmental:☐Yes ☐ No: Farm suppliers must participate inAEM at Tier 2.
□ Wine:NYRequirement:☐Yes ☐ No: Minimum 75% grapes/fruit (by volume) grown in New York.☐Yes ☐ No: 100%ofNYgrapesmustbefromNYSGrown&Certifiedfarms.Food Safety:☐Yes ☐ No: Beveragemanufacturers must havea20-CORfarmwinery license. Any inspectionrelatedissues must be resolvedwithin30 days.Environmental:☐Yes ☐ No: Farms must participatein AEM at Tier 2.
□ Cider:NYRequirement:☐Yes ☐ No: 100% apples or other pome fruit (by volume) must be from NYS Grown& Certifiedfarms.Food Safety:☐Yes ☐ No: Beveragemanufacturers must havea20-CORfarm cidery license. Any inspectionrelatedissues must beresolved within 30 days.Environmental:☐Yes ☐ No: Farms must participatein AEM at Tier 2.
Environmental:
Yes No Farm suppliers must participate in AEM at Tier 2.
Proxima Nova is used on all collateral related to the
NYSGC programs. Headlines may be set in uppercase
Proxima Nova Bold, and subheads may be a mix of
uppercase and lowercase Regular, SemiBold, and Bold,
depending on individual needs. Proxima Nova can be
purchased from myfonts.com.
Proxima Nova RegularProxima Nova Regular ItalicProxima Nova SemiBoldProxima Nova SemiBold ItalicProxima Nova BoldProxima Nova Bold Italic
13
Spirits:NYRequirement:
s☐No:Minimum75%offruits,vegetables,grainandgrain products, honey, maple sap or other☐YeagriculturalproductsmustbegrowninNY.100%oftheseinputsmustbefromGrown&CertifiedFarms.FoodSafety:☐Yes No:Manufacturersmusthavea20-ClicenseORfarmdistillerylicense.Anyinspectionrelatedissuesmustberesolvedwithin30days.Environmental:☐Yes☐No:FarmsmustparticipateinAEMatTier2.
□ Spirits:NYRequirement:☐Yes ☐ No: Minimum 75% of fruits, vegetables, grain and grain products, honey, maplesap, or otheragriculturalproductsmustbegrowninNY.100%oftheseinputsmustbefromGrown&CertifiedFarms.Food Safety:☐Yes ☐ No: Manufacturers must havea20-Clicense ORfarm distillery license.Anyinspectionrelatedissuesmustberesolvedwithin30days.Environmental:☐Yes ☐ No: Farms must participatein AEM at Tier 2.
□ BeverageIngredient Producer:NYRequirement:☐Yes ☐ No: 100%GrowninNYFood Safety:☐Yes ☐ No: Applicable at processor/manufacturer level. Manufacturers must have a20-CLicense ORfarm brewery/distillery/cidery/winery license.Environmental:☐Yes ☐ No: Farms must participate inthe Agricultural Environmental Management administeredbythe Department of Agriculture andMarkets, withthe completionof Tier 2 of the program (or higher)withinthe past three years. Grape growers may substitute the Vine Balance Program for AEM.
If youansweredNotofulfilling any of the above requirements, please indicatehow, and thetimeframein which you will fulfill them:
Thirdpartyfoodsafety/safeegghandlingauditprogram.Farms with offsite packing houses:
Yes No
Yes No
Yes No
Yes No
Yes No
Environmental:
Yes No Producer, or majority of producers, participate in New York State AgriculturalEnvironmental Management (AEM) program with the completion of Tier 2or higher within the past 3 years or has a CAFO permit.
P E C O N I C L A N D T R U S T
□ Sheep & Goat:NYRequirements:☐Yes☐No:Lambs/kids are born in New York State☐ Yes ☐ No: Ewes/does have lived in New York State for 1 year☐ Yes ☐ No: Breeding for lambs/kids occurs in New York StateFoodSafety:☐Yes☐No:Animalsareslaughtered/processedinaUSDAInspectedSlaughterPlant.☐Yes☐No:ParticipationinNew York State Sheep/Goat Health Assurance Program (NYSSGHAP).Environmental:☐Yes☐No:ProducerormajorityofproducersparticipateintheNewYorkStateAgricultural EnvironmentalManagement(AEM)program,administeredbytheDepartmentofAgricultureand Markets,withthecompletionofTier2oftheprogram(orhigher)withinthepastthreeyearsORhasa CAFOpermit.