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KOPERASI
PERMATA GAYO
Nomor DH : 518/0391 DH 1V12006
JIn. Syiah Utama No.66 Kampung Simpang Utama. Kecamatan Bandar
Kabupaten Beuer Meriab, Nanggroe Aceb Darussalam - 24582 - Indonesia
302 W. Lamar St. Suite E.
Americus. GA 31709 USA
Tel.+ 1-229-924-3035, Fax. +1-229-924-6250
Attn: Chelsea Garter
ShioDedby:
V.095N
From:
Belawan, Indonesia
Consignee:
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
Email: 2avooermatata1
088/INV/PGC/2011/2012
FLO ID 6589
FLO ID buyer: 1341
FDA REG NO.1309672374O
B/LNumber:
BLWNYC2IOOl DD.
To:
New York/ NY
Container/Seal No:
HJCU8425473 / HC356637
Connecting Vessel:
Uons Gate Bridge V.OO57W
300 (three hundred) Bags of 60 Kgs Net Each Bag
SUMATRA PERMATA GAYO HIGHLAND
ARABIC A DP GRADE 1 GREEN COFFEE
FLO F AIRTRADE & ORGANIC CERTIFIED
Contract No.
SUG1216
Gross Weight : 18,300 Kgs
Ta re 300 Kgs
Nett Weight : 18,000 Kgs
Price : US$. 5,247.70/Mtons
Organic Premium : US$. 661.38/Mtons
Fairtrade Premiun : US$. 44Q.92IMtons
Price total : US$. 6,350.00/Mtons
FOB Belawan NSW as per contract no.sUG1216
Say: One Hundred Fourteen Thousand and Three Hundred Dollars only.
- Insurance to be covered by buyer
- Freight Collect
- Payment CAD
- "This caroo/coffee has not been refused
Harks & Nos. Notify Party:
PGC EXCELCO TRADING L.P.
US$. 94,458.60
US$. 11,904.84
US$. 7,936.56
US$. 114,300.00
015/1730/88 17 BATIERYPLACE, SUITE 1010
SUG 1216 NEW YORK,NY 10004
FLO ID : 1341 TEL. + 1-212-344-6771
SUMATRA GAYO MOUNTAIN FAX. + 1-212-344-8723
GREEN ARABICA COFFEE ATTN: GEORGE TSIASTSIOS
DP GRADE 1
FLO F AIR TRADE + ORGANIC
CERTIFIED
In CU : 812234
FLO ID: 6589
PROD OF INDONESIA
NETT60KGS
NEW YORK
1-300 ,;,p • r I
Please cable our payment to :... ... .............. PT.BANK NEGARA INDONESIA (PERSERO) TBK
USU MEDAN BRANCH,with Account NO..... : 186412423 (USD) on behalf of KOPERASI PERMATA
GAYO, SWIFf CODE: BNINIDJA USU
(
I r>// Ir A m'a
C·TPAT NO. 72545308
OTI LICENSE NO. 17577NF
IJNIVERSAL SHIPPING, INC.
ORIGINAL BILL OF LADING
Shipper (Full NamelAddresslTellContact Person) Document No. Bill of Lading No.
KOPERASI PERMATAGAYO BLWNYC2I001 BLWNYC2I001
JLN.SYIAH UTAMA NO.66 KAMPUNG SIMPANG UTAMA
Llcen•• No. OTt Llcen.e No.
KEC.BANDAR KAB.BENER MERIAH, ACEH-24582
17577NF
INDONESIA
Point and country of origin of goods
Consignee (Full NameiAddresslTeUContad Person) Delivery Agent (Full Name/AddresslTelleontacl Person)
TO THE ORDER OF COOPERATIVE COFFEES INC UNIVERSAL SHIPPING. INC.
302 W.LAMAR ST. SUITE E AMERICUS, GA 31709 USA 2855 S. RESERVOIR STREET
TEL.++1-229-924-303S, FAX.+1-229-924-6250 POMONA, CA, USA 91766
ATTN:CHELSEA CARTER LOS ANGELES. UNITED STATES,UNITED STATES
TEL:1·9Q9..628-2226 FAX:1-909-628-2221
Notify Party (Full NamelAddressJTel/Contact Person) Also Notify Party (Full NameiAddressfTei/Cont8ct Person)
EXCELCO TRADING L.P
17 BATTERY PLACE, SUITE 1010 NEW YORK. NY 10004
TEl.+1-212-344-6771 FAX.+1-212-344-8723
ATTN:GEORGE TSIASTSIOS (GTSIATSIOS@EXCELTRADE.COM)
Ves..Woyage By Type of Movement
QUEZON BRIDGE 095N FCL/FCL CY/CY
Place of Receipt Port of Loading Port of Discharge rtace of Delivery
BELAWAN, INDONESIA BELAWAN, INDONESIA NEW YORK, NY YORK, NY
Date Cargo Received Date Laden on Board Loading PlerlTermlnal [Original to be Released at
16 Sep 2012
PARTICULARS FURNISHED BY SHIPPER
Container No.s w/Seal No.8 I Quantity
I
Description of Packages and Goods
I Gross Weightl Measurement
Marks & Numbers Packages (KGs) (CBM)
HJCU8425473 1 HC356637 1 20' GP 1 300 BG(S) / 18300.000 KG(S) / 25.000 CBM / FCL/FCL CY/Cy

PGC 300 BG 1X20'FT CONTAINER: 18300.000 25.000
015/1730/88
SUG 1216 300 BAGS OF 60 KGS NET EACH BAG
FLO ID : 1341 SUMATRA PERMATA GAYO HIGHLAND ARABICA
SUMATRA GAYO MOUNTAIN DP GRADE 1 GREEN COFFEE FLO FAIRTRADE
GREEN ARABICA COFFEE & ORGANIC CERTIFIED
DP GRADE 1
FAIR TRADE FLO + FDA REG NO. 13096723740
ORGANIC CERTIFIED
ID CU : 812234 NET WEIGHT: 18000.000 KGS
FLO ID : 6589 FREIGHT COLLECT
PROD OF INDONESIA
NETT 60 KGS
NEW YORK, NY
1-300

Temperature Control Instructions;
IExcess Value Declaration
Freight Rate & Charges Ife- of title I1I1II of LadIng CCIIIIInued 011 __side ...., It WITHE&8
Description Unit ChargelUnit Exch.Rate Amount(P/Cl
.... REOF !lie IIIaiiH 3 0rigIMI8111s of LadIng, .. of title Ear and
_ ofwhlch !lie oIher -..void.
Date
1 fi 21J1!
Biped By:
IFIRST ORIGINAY
.1'1
,,/
I iiiii
I C
!,............... ,
i.'¥DQWSA
C·TPAT NO. 72545308
OTI LICENSE NO. 17577NF
tJNIVERSAL SHIPPING, INC.
ORIGINAL BILL OF LADING
PARTICULARS FURNISHED BY SHIPPER
Container No.s wlSeal No,sl
Marks & Numbers
Quantity
Packages
I
Description of Packages and Goods
IGross Weigh, Measurement
(KGs) (CaM)
GRAND TOTAL: 300 BG(S) THREE HUNDRED BAG(S) ONLY 18300.000 25.000
1. Body issuing the certificate (name and address)
Control Union certifications B.V.
Meeuwenlaan 4-6
8011 BZ ZWOLLE
NETHERLANDS
3. Seller ofthc product (name and eddress)
Koperasi Perm.t. Gayo
Jl. Syiah UI.ma. No. 66 Kampung Simpang Utama. Pondok Baru;Kab. Bentt
MeriahAceh Tengah .
Nanggroe Aceh Darussalam
INDONESIA
5. Producer or processor ofthe product" addre!Js)
Koperasi Permata Gayo (Bromo
JI. Bromo Ujung, Gang
Sumatera Utara
INDONESIA
Cooperative
302
GA
.
; Gayo
; (irl!<le FLO and Orsonic Certified
Pr04oUriSloneslalPMkcdjn.l}mts.60 Kgs in3l!O bags

!nvcijctj

1;.;.O$llJ!.l'.<'Vrroci:20U/Z012 <id. 14.ffl-12
.. !BLWNyqlOOI . d.d 16-0CJ-J2
..IUCU84;!547-a
:Pe!l)la1a Gli:l'oCoop.rative ldentifrca(ion Nwnber:OI5!17301l!8'sUG 1216 Seal Number :HC356637 Shipping
. Snipping,lllt '

'; .. Box 4' rbc inSJiection andce;rtifi . atinnbody for compliance with the rules on fr<>m organic production methods..
80)( lhelastoperllt'on (processing, rackaging, labelling) on the bateh.
TRANSACTION CERTIFICATE
USA FOR PRODUCTS FROM NOP ORGANIC PRODUCTION
.I1rm":here Iile batcli will be delivered, ifdifferent from the address in box 7.
'·;.:lrVll1,3:l".l! v.o!Url>J;itpneieri, given, "!here appropriate, in supplement 10 the declilrations in boxes II and 12.
2.Th. National Organic Program standards of the Uniled Stales Department of
Agriculture/Control Union Certifications standards
Reference number of the certificate: PRJ 8122341255279
A.IIlIljle!:tiGI!QOOy" (name and aiWess)
·CQntrol Union certifications' B.V.
l\-1eeuwenlian 4-6
$Oil Hi ZWOLLE
NEl'HERLA1'-.'US
6,· CQ1lII!ry or dispatch
INDoNESIA
8. Country of destination
UNITED STATES
9. Address and pl""e ofdestinatio';'
Lotlba(ch Gross mass Net mass
Year num.ber< (kgs) (kgsl
2012 18300.00 18000.00
1 I Gross maSs
18300.00 kgs
12. 'Net mass
18000.00 kgs
13. Alternative units'

Related Interests

1;.;.O$llJ!.l'.<'Vrroci:20U/Z012 <id. 14.ffl-12
.. !BLWNyqlOOI . d.d 16-0CJ-J2
..IUCU84;!547-a
:Pe!l)la1a Gli:l'oCoop.rative ldentifrca(ion Nwnber:OI5!17301l!8'sUG 1216 Seal Number :HC356637 Shipping
. Snipping,lllt '

'; .. Box 4' rbc inSJiection andce;rtifi . atinnbody for compliance with the rules on fr<>m organic production methods..
80)( lhelastoperllt'on (processing, rackaging, labelling) on the bateh.
TRANSACTION CERTIFICATE
USA FOR PRODUCTS FROM NOP ORGANIC PRODUCTION
.I1rm":here Iile batcli will be delivered, ifdifferent from the address in box 7.
'·;.:lrVll1,3:l".l! v.o!Url>J;itpneieri, given, "!here appropriate, in supplement 10 the declilrations in boxes II and 12.
2.Th. National Organic Program standards of the Uniled Stales Department of
Agriculture/Control Union Certifications standards
Reference number of the certificate: PRJ 8122341255279
A.IIlIljle!:tiGI!QOOy" (name and aiWess)
·CQntrol Union certifications' B.V.
l\-1eeuwenlian 4-6
$Oil Hi ZWOLLE
NEl'HERLA1'-.'US
6,· CQ1lII!ry or dispatch
INDoNESIA
8. Country of destination
UNITED STATES
9. Address and pl""e ofdestinatio';'
Lotlba(ch Gross mass Net mass
Year num.ber< (kgs) (kgsl
2012 18300.00 18000.00
1 I Gross maSs
18300.00 kgs
12. 'Net mass
18000.00 kgs
13. Alternative units'

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