PRIVATE SPONSOR TRAVEL CERTIFICATION FORM
This form must be completed by any private entity offering to provide travel or reimbursement for travel to Senate Members, Officers, or employees (Senate Rule 35, clause 2). Each sponsor of a fact-finding trip must sign the completed form. The trip sponsor(s) must provide a copy of the completed form to each invited Senate traveler, who will then forward it to the Ethics Committee with any other required materials. The trip sponsor(s) should NOT submit the form directly to the Committee. Please consult the accompanying instructions for more detailed definitions and other key information. The Senate Member, Officer or employee MUST also provide a copy of this form, along with the appropriate travel authorization and reimbursement form, to the Office of Public Records (OPR), Room 232 of the Hart Building, within thirty (30) days after the travel is completed.
1. Sponsor(s) of the trip (please list all sponsors):North Carolina Agribusiness Council;* North Carolina_ Department of Agriculture and Consumer Services**; North Carolina Agricultural and Technical State_ University – School of Agriculture and Environmental Sciences**( Total 3 sponsors) *funds; **in-kind_
2. Description of the trip: An Agricultural Tour that will include stops at major agribusiness operations,__ university and research facilities, as well as farming operations across central North Carolina with a focus on such topics and issues as immigration, energy, sustainable agriculture, water and environmental _____ stewardship, farmland preservation, animal welfare and food safety.______
3. Dates of travel: August 24, 2009 thru August 27, 2009 _(72 hours total)______
4. Place of travel:_ Washington DC to Raleigh, Oxford, Greensboro, Lewisville, Winston-Salem, Belews Creek, Tobaccoville, Statesville, Salisbury, China Grove, Pinehurst, Vass, Carthage, Siler City, Raleigh – North Carolina back to Washington DC.______
5. Name and title of Senate invitees:_____See attached list_(attachment #1)______
6. I certify that the trip fits one of the following categories:
Ö(A) The sponsor(s) are not registered lobbyists or agents of a foreign principal and do not retain or employ registered lobbyists or agents of a foreign principal and no lobbyist or agents of a foreign principal will accompany the Member, officer, or employee at any point throughout the trip.
OR
_(B) The sponsor or sponsors are not registered lobbyists or agents of a foreign principal, but retain or employ one or more registered lobbyists or agents of a foreign principal and the trip meets the requirements of Senate Rule 35.2(a)(2)(A)(i) or (ii) (See Question 9). Not Applicable
7. Ö I certify that the trip will not be financed in any part by a registered lobbyist or agent of a foreign principal.
AND
Ö I certify that the sponsor or sponsors will not accept funds or in-kind contributions earmarked directly or indirectly for the purpose of financing this specific trip from a registered lobbyist or agent of a foreign principal or from a private entity that retains or employs one or more registered lobbyists or agents of a foreign principal.
8. I certify that:
Ö The trip will not in any part be planned, organized, requested or arranged by a registered lobbyist or agent of a foreign principal except for de minimis lobbyist involvement. AND
Ö The traveler will not be accompanied on the trip by a registered lobbyist or agents of a foreign principal except as provided for by Committee regulations relating to lobbyist accompaniment (See question 9).
9. USE ONLY IF YOU CHECKED QUESTION 6(B) – Not Applicable
I certify that if the sponsor or sponsors retain or employ one or more registered lobbyists or agents of a
foreign principal, one of the following scenarios applies:
o (A) The trip is for attendance or participation in a one-day event (exclusive of travel time and one overnight stay) and no registered lobbyist or agents of a foreign principal will accompany the Member, officer, or employee on any segment of the trip.
OR
o (B) The trip is for attendance or participation in a one-day event (exclusive of travel time and two overnight stays) and no registered lobbyist or agents of a foreign principal will accompany the Member, officer, or employee on any segment of the trip (See Questions 6 and 10).
OR
o (C) The trip is being sponsored only by an organization or organizations designated under Section 501(c)(3) of the Internal Revenue Code of 1986 and no registered lobbyist or agents of a foreign principal will accompany the Member, officer, or employee at any point throughout the trip.
10. USE ONLY IF YOU CHECKED QUESTION 9(B)
If the trip includes two overnight stays, please explain why the second night is practically required for
Senate invitees to participate in the travel: ____Not Applicable______
11. Ö An itinerary for the trip is attached to this form. I certify that the attached itinerary is a detailed (hour-by-hour), complete, and final itinerary for the trip. (See Attachment #2)
12. Briefly describe the role of each sponsor in organizing and conducting the trip: All three sponsors___ participating in selecting various aspects of the tour and coordinating logistics at various stops on the tour; all three sponsors participated in inviting participants on the tour, but only the NC Agribusiness Council will be paying for all expenses for all aspects of the tour.______
13. Briefly describe the stated mission of each sponsor and how the purpose of the trip relates to that
mission:_North Carolina Agricultural & Technical State University - School of Agriculture and___ Environmental Sciences will provide opportunities for individuals from diverse backgrounds to achieve excellence, through intellectual and technological advancements, in the food, agricultural, environmental and life sciences that will cultivate and enhance their potential for global leadership, productivity and___ competitiveness. The mission of the North Carolina Department of Agriculture and Consumer____ Services is to improve the state of agriculture in North Carolina by providing services to farmers and___ agribusinesses, and to serve the citizens of North Carolina by providing services and enforcing laws to__ protect consumers. The mission of the North Carolina Agribusiness Council is to raise awareness of the state’s # 1 industry and the significant contribution of agribusiness to North Carolina’s economy and___ advance agribusiness interests and programs, thereby increasing employment and expanding agribusiness opportunities in North Carolina. _The purpose of the AgTour trip is to raise awareness, increase_____ understanding and provide insight into the various segments of the agriculture and agribusiness industry and explore and discuss issues, challenges, concerns and opportunities affecting this industry - both in__ North Carolina as well as the southeastern part of the United States. ______
14. Briefly describe each sponsor’s prior history of sponsoring congressional trips: North Carolina____ Agricultural & Technical State University – School of Agriculture and Environmental Sciences and the_ North Carolina Agribusiness Council have not sponsored prior congressional trips. The North Carolina_ Department of Agriculture and Consumer Services has partnered in the past with other agricultural____ organizations to sponsor congressional trips – but no sponsorships have been done since the new___ ethics rules were implemented.______
15. Briefly describe the educational activities performed by each sponsor (other than sponsoring
congressional trips): As a land-grant university, the goal of North Carolina Agricultural & Technical State University – School of Agriculture and Environmental Sciences is to provide students with___ understanding and skills to address the problems of the agricultural economy and to help those involved in it lead more productive and satisfying lives. Through various delivery modes, the North Carolina A&T Cooperative Extension Program provides research-based educational programs and information regarding critical issues to individuals, families and communities. Cooperative Extension's educational programs__ and outreaches also emphasize improving the quality of life for individuals and families without the____ financial resources and educational backgrounds mainstream America enjoys. The North Carolina____ Department of Agriculture and Consumer Services divisions have responsibilities in regulatory and_ service areas covering agronomy; animal health; weights and measures; gas and oil inspection; crop and livestock statistics; USDA commodity distribution; state farm operations; food, drug and cosmetic testing for purity; agricultural marketing and promotion; agricultural marketing grading; international______agricultural crop and livestock marketing; operation of the North Carolina State Fair and North Carolina Mountain State Fair; operation of five state farmers markets; research station operations; seed and_____ fertilizer inspection; nursery and plant pest eradication activities; regulation of the structural pest control industry; agricultural environmental issues; state and federal agricultural legislation; and agricultural___ economic analysis develops and delivers many educational programs and information resources that help farmers be successful. The North Carolina Agribusiness Council is a non-profit, non-partisan, advocacy organization (which represents all aspects of the agribusiness industry, including farmers, ranchers,_____ suppliers, manufacturers, processors, financiers, transporters, wholesalers, retailers, marketers,______communicators and various commodity groups) that seeks to increase awareness of NC's agribusiness industry and its vital importance to the overall economic well-being of the state and nation; evaluate the strengths and weaknesses of the state's agribusiness and the potential for future growth; promote greater unity of interest among different agribusiness enterprises, including producers, processors, suppliers, financiers, transporters, wholesalers, and retailers; and make NC a leader among states in agribusiness, increasing employment and expanding business opportunities through educational outreach, such as issue workshops, forums, local meetings and newsletters.
16. Total Expenses for Each Participant: See attached sheet for specific daily expense detail - all of which are good faith estimates based on quoted prices from vendors. (Attachment #3
Transportation Lodging Meal Other Total
Expenses Expenses Expenses Expenses Expenses
$301.34 / $266.00 / $137.00 / $9.00 / $713.3417. State whether a) the trip involves an event that is arranged or organized without regard to congressional participation or b) the trip involves events that are arranged or organized specifically with regard to congressional participation:_The AgTour includes both an event that is arranged without regard to congressional participation as well as events that are arranged specifically with regard to congressional participation. The AgLeaders Banquet on Monday evening, August 24th is an annual event that involves_ between 500 – 700 people from across North Carolina. The rest of the AgTour is being arranged______specifically with regard to congressional participation – although state officials and other individuals___ interested in learning more about the industry will also be invited on the tour. (No federal lobbyists!)____
18. Reason for selecting the location of the event or trip: _The locations were selected due to proximity to each other and type of organization so as to showcase all aspects of the agricultural and agribusiness___ industry in a 72-hour tour – with minimal travel time between stops on tour.______
19. Name and location of hotel or other lodging facility: _Hilton North Raleigh, Raleigh, NC; Marriott__ Winston-Salem, Winston-Salem NC; and Pinecrest Inn, Pinehurst, NC______
20. Reason(s) for selecting hotel or other lodging facility: Each hotel was selected based on price, (within
per diem guidelines); ability to accommodate group size; and proximity to first and last stops on tour.___
21. Describe how the daily expenses for lodging, meals, and other expenses provided to trip participants
compares to the maximum per diem rates for official Federal Government travel:
All expenses for meals, lodging and other expense will fall within the maximum per diem rates for the_ four areas in North Carolina being visited (Raleigh, Winston-Salem, Greensboro and Fayetteville)._____
22. Describe the type and class of transportation being provided. Indicate whether coach, business-class or first class transportation will be provided. If first-class fare is being provided, please explain why firstclass travel is necessary: _Transportation to/from Washington DC and Raleigh, NC will be provided via American Airlines/American Eagle - Coach. During the AgTour a privately-chartered tour bus will be rented from Holiday Tours in order to accommodate the group during the three day tour.
23. Ö I represent that the travel expenses that will be paid for or reimbursed to Senate invitees do not include expenditures for recreational activities or entertainment (other than entertainment provided to all attendees as an integral part of the event, as permissible under Senate Rule 35)
24. List any entertainment that will be provided to, paid for, or reimbursed to Senate invitees and explain
why the entertainment is an integral part of the event:______Not Applicable______
25. I hereby certify that the information contained herein is true, complete and correct. (You must include
the completed signature block below for each travel sponsor):
Signature: ___________
Name and Title: ___Erica Upton Peterson, Executive Vice President______
Organization: ___North Carolina Agribusiness Council______
Address: __2500 Regency Parkway, Cary, NC 27518______
Telephone Number: ____919-782-4063______
Fax Number: ______919.654.6737______
E-mail Address: ______
Signature: ____________
Name and Title: ____Dr. Alton Thompson, Interim Provost______
Organization: _North Carolina Agricultural and Technical State University______
Address: _____ 1601 E. Market St. - 111 Webb Hall, Greensboro, NC 27411______
Telephone Number: __336-334-7979______
Fax Number: ______336.334.7136______
E-mail Address: _____ ______
Signature: __________
Name and Title: _____Steve Troxler, Commissioner of Agriculture______
Organization: _North Carolina Department of Agriculture and Consumer Services______
Address: _____ 2 West Edenton Street, Raleigh, NC 27601______
Telephone Number: ____919.733.7125______
Fax Number: ______919.733.1141______
E-mail Address: ______
Attachment #1
List of Senate InviteesTitle / First / Last / Office
Staff Assistant / Graham / Harper / Senate Committee on Agriculture
Staff Assistant / Susan / Keith / Senate Committee on Agriculture
Chief Economist / Stephanie / Mercier / Senate Committee on Agriculture
Legislative Assistant / Ashley / Palmer / Senator Bob Corker
Legislative Assistant / Justin / Spickard / Senator Bob Corker
Legislative Assistant / Jacqueline / Gelb / Senator Jim DeMint
Legislative Assistant / Trevor / Dean / Senator Jim Webb
Legislative Assistant / Maribel / Ramos / Senator Jim Webb
Legislative Assistant / Christopher / Cook / Senator Johnny Isakson
Legislative Assistant / Patrick / Brennan / Senator Kay Hagan
Deputy State Director / Tony / Caravano / Senator Kay Hagan
Legislative Assistant / Julie / Holzhueter / Senator Kay Hagan
Chief of Staff / Crystal / King / Senator Kay Hagan
Scheduling Director / Catherine / Michaels / Senator Kay Hagan
State Director / Melissa / Midgett / Senator Kay Hagan
Legislative Assistant / Tom / Craig / Senator Lamar Alexander
Legislative Correspondent / Morgan / Petty / Senator Lamar Alexander
Constituent Relations Representative / Laura / Ray / Senator Lamar Alexander
Legislative Assistant / Laura / Bauld / Senator Lindsey Graham
Director of Legislative Correspondence / Courtney / Flezzani / Senator Lindsey Graham
Senior Legislative Correspondent / Nicholas / Devereux / Senator Mark Warner
Chief of Staff / Chris / Joyner / Senator Richard Burr
General Counsel / Andy / Moskowitz / Senator Richard Burr
Legislative Correspondent / Margaret / Brooks / Senator Richard Burr
Director of Economic Development / Chris / Wall / Senator Richard Burr
Legislative Assistant / Bridges / Sinyard / Senator Saxby Chambliss
Attachment #2