You are on page 1of 5

Closed at $2.

65 on December 20, 2016


-
BILL OF LADING FOR OCEAN TRANSPORT SCAc MAEU
OR MULTIMODAL TRANSPORT
B/LNo 959006519
Shipper Booking No.
KOPERASI PERMATA GAYO 959006519
JL.SYIAH UTAMA N0 .66 KAMPUNG SIMPANG UTAMA
Export references Svc Contract
KEC.BANDAR, KAB.BENER MERIAH, ACEH-24582 INDONESIA
21473058
Onward inland routing (Not part of carriage as defined in clause 1. For account and risk of Merchant}

Consi9nee ( negotiable only if consigned "to order", "to order or' a named Person or ~to order of bearer''} Notify Party (see clause 22)
TO THE ORDER OF COOPERATIVE COFFEES INC EXCELCO TRADING L.P.
302 W.LAMAR ST, SUITE E AMERICUS, GA 31709 USA 17 BATTERY PLACE, SUITE 1010
TEL.+ 1-229-924-3035, FAX.+ 1-229-924-6250 NEW YORK, NY 10004
ATTN: BECKY JOHNSTON TEL.+ 1-212-344-6771, FAX.+ 1-212-344-8723
FLO ID:1341 ATTN:GEORGE TSIATSIOS
(GTSIATSIOS@EXCELTRADE.COM)

Vessel (see dause I + 19) Voyage No. Place or Receipt Applicable only when document used as Multimodal Transport 8/L. (see dause 1)
MERATUS MEDAN 5 1702

Port of Loading Port of Discharge Place or Delivery. App\icable only when document used as Multimodal Transport 8/L. (see clause I)
Belawan Newark

PARTICULARS FURNISHED BY SHIPPER


Kind of Packages; Description of go<Xls; Marks and Numbers; Container No./ Seal No. ~ Weight Measurement

18300.000 KGS 25.0000 CBM


1 Container Said to Contain 300 BAG

300 BAGS OF 60 KGS NET EACH BAG


SUMATRA PERMATA GAYO HIGHLAND ARABICA DP GRADE 1 GREEN COFFEE
FLO FAIRTRADE & ORGANIC CERTIFIED

NET WEIGHT = 18,000 KGS


FDA REG N0.1309 6~ 3]40
#' ,,
PGC
015/1730/20
SUG174
FLO ID : 1341
SUMATRA GAYO MOUNTAIN
GREEN ARABICA COFFEE
DP GRADE 1
FAIRTRADE FLO + ORGANIC CERTIFIED
ID CU : 812234
FLO ID : 6589
PROD OF INDONESIA
NETI 60 KGS
NEWARK, NJ
1-300

bove partteulars as declared by Shipper, but without responsibility of or represertation by Carrier (see dause 14}
Freight & Charges Rate Un~ Currency Prepaid Collect

earner's Receipt {see dause 1 and 14). Total number Place of Issue of 8/L
of containers or packages received by Carrier.
Medan
1 container

Signed for the carrier Maersk Line A/5

This transport document has one or more numbered pages As Agent(s)

n
2015A1 00 1'2
B/L: 959006519 Page : 2
-
TCLU2401166 ML-ID2220734 20 DRY 8'6 300 BAG 18300.000 KGS 25 .0000 CBM
SHIPPER'S LOAD, STOW, WEIGHT AND COUNT

FREIGHT COLLECT

CY/CY

Freight & Charges Rate Unit Currency Prepaid Collect

2015A1
T RANSACTION CE RTIFI CATE

USA FOR PRODUCTS FROM NOP O RGAN IC PROD UCTION

I. Body issuing the certificate (name and address) 2 a) The National Organic Program standards of the United States Departmen t of
Control Union Certifications B.V. Agriculture/Control Union Certifications standards
Meeuwenlaan 4-6 2 b) Reference number of the certificate: PRJ 812234/712279
8011 BZ ZWOLLE
NETHERLANDS
3. Seller of the product (name and address) 4. Inspection body* (name and address)
Koperasi Pennata Gayo Control Union Certifications B.V.
JI. Syiah Utama, No. 66 Kampung Simpang Utama, Pondok Baru Meeuwenlaan 4-6
24582 Bener Meriah 8011 BZ ZWOLLE
Aceh NETHERLANDS
INDONES IA
5. Producer or processor of the product (name and address) 6. Country of dispatch

K operasi Permata Gayo (Bromo Ujung) INDONESIA


JI. Bromo Uju ng, Gang lkh las No. 2Medan
Sumatera Utara
INDONES IA
7. Consignee (name and address) 8. Country of destination
UN ITED STA TES OF AMERICA
Cooperative Coffees Inc.
302 L amar Street Suite E
GA 31709 Americus
9. Address and place of destination
UN ITED STA TES OF AMERICA
10. Marks and numbers, container no(s), number and kind. Trade name of the product. 11. Gross mass
Production Lot/batch Gross mass Net mass
NOP certified
Year numbers (kgs) (kg s) 18300.00 kgs

I 00% organic Sumatra Pemiata Gayo Highland Arabica Coffee (Sumatra Gayo
Mountain Green Arabica Coffee DP Grade- I Organic and Fairtrade Certified) 2016 18300.00 18000.00 12 . Net mass
packed in Unit 60 kg in 300 bags 18000.00 kgs
from organic production methods.
Invoice no.: 020/ INV/ PGC/2016/2017 d.d. 29-12-16 13. Alternative units
Transport document no.: 959006519 d.d. 03-01-17
Container no.: TCLU240116-6
Identification codes : Pennata Gayo Coop Identification Code:015/1730/20 SUG-174, Seal No.ML-ID 2220734, Shipping Company :
MAERSK LINE
,,

14. Declaration of the body issuing the certificate

15. Additional declaration (if appropriate)

Certified in compliance with the tenns of the US-Canada Organic Equivalency Arrangement.

~
16. Place and date of issue Jakarta, IO January QO 17 Stamp of the 1 sr ng body
Name and signature of authorised person
1h behalf of n ging Director
,,
0 0
;? '
u
~ j ~. . (Winaryo)
CormilU!'IIOrl~
~ acar.dlld b)' h LIMN
<"~Rnf\~<:> s-~(J~

*Explanatory notes
Box 4: The inspection and certification body fo r compliance with the rules on from organic production methods ..
Box 5: The Jinn which carried out the last operation (processing, packaging. labelling) on the batch .
Box 9: T he address of the firm where the batch will be delivered, if different from the address in box 7.
Box 13: e.g. volume in meters. to be given, where approp riate, in supplement to the declarations in boxes 11 and 12.