1688 W. Adams St. Phoenix, AZ 85007
Phone: 602-542-4293 Fax: 602-542-4290
The Arizona Department of Agriculture (ADA) in conjunction with the US Department of Agriculture (USDA)
provides for participation by Arizona producers in the NPIP.
Flock Owner Facility Name
Mailing Address Physical Address
City, State, Zip City, State, Zip
Phone E-mail Address
ADA Agreement:
To perform inspection and administrative work in compliance with NPIP.
Flock Owner Agreement
To fulfill and maintain all requirements for membership and participation in the NPIP.
To record, maintain, and make available to ADA all records as required, and to submit white
copies of VS Form 9-2 or AZ SVO Form 5-2 within 30 days to the ADA.
Are subject to annual inspections and recertification to renew participation as prescribed by the
provisions and regulations.
Required to keep poultry stock segregated from other poultry and in accordance with the
provisions of the Plan and regulations of the State agency.
Acceptance and compliance with NPIP will allow participating flock owner to use prefix "US" in connection
with other official terms in describing, advertising, and selling hatching eggs, young birds, and breeding stock
that meet the breeding stage and pullorum class of the operation.
Cancellation of agreement is voluntary by participant and shall be renewed based upon compliance with
participation requirements annually, but may be canceled:
By the member upon written notice to the Office stating intention to withdraw from participation in
the NPIP.
By the Office at any time upon written notice to the member for violation of regulations
By not participating in annual renewal cancellation will be automatic
In case of cancellation or termination of this agreement, the member agrees to forfeit all rights and benefits of
membership with the Office and participation in the NPIP.
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Participating Flock Owner Date