Property of Brinker International - Confidential

BRINKER INTERNATIONAL NUTRITION QUESTIONNAIRE

Date Completed

Company Name

Address

Supplier Product Label Name

Manufacturing Item #

Case Pack: No of packs/size per pack and unit of measure (e.g. 2 / 6 Gallon jugs; 5 / 2 lb bags)

Country of Origin (Seafood Only)

Brinker Brand Using Product: Chili’s, Maggiano’s or Brinker if product is used by both Brands.

Please express serving size based on household measure (e.g. cups or teaspoons) or as a whole discrete unit if product is sold as such (e.g.1 steak, cookie, or slice of bread) Note: Serving size shall only be listed as a fraction of a unit for multi-serving products (e.g.1/3 of a pizza or 1/16 of sheet cake) Serving Size (drop down menu of serving size options) _________= ______ grams (g) Teaspoon, tablespoon, cup, fluid ounces, pint, quart, gallon, piece, slice, etc. Report data using unrounded values to the hundredth decimal place and base on 100 grams (e.g. Calories (kcal): 472.54)

Nutrients REQUIRED Per 100 g

Calories (kcal) Calories from Fat (kcal) Fat (g) Monounsaturated fat (g) Polyunsaturated fat (g) Saturated Fat (g) Trans Fatty Acid (g) Cholesterol (mg) Sodium (mg) Carbohydrates (g) Dietary Fiber (g) Total Sugars (g) Protein (g) Water (g) Ash (g)

Property of Brinker International - Confidential

INGREDIENT SPECIFICATION

Ingredient Specification X if in product X if in other product(s) produced in plant

Egg e.g. frozen yolk, egg white powder and egg protein isolates or derivatives

Fish e.g. salmon and tilapia

Wheat e.g. flour, brans or derivatives

Gluten e.g. wheat, barley, rye and cross varieties of grains

Milk e.g. lactose, casein, milk caseinate, cheese, cream, whey and yogurt powder or derivatives

Shellfish-Mollusks e.g. snails, scallops, clams, mussels, oysters, cockle or derivatives including extracts

Shellfish-Crustaceans e.g. shrimp, lobster, crab and other seafood with “shell”

Peanuts e.g. peanut pieces, protein, flour, butter or derivatives, does not include oil*

Soy e.g. lecithin, tofu, protein isolates, tempeh, miso, tamari and hydrolyzed plant protein, does not include oil*

Tree nuts e.g. almonds, Brazil nuts, cashews, hazelnuts, hickory, macadamia, pecans, pine nuts, pistachios and walnuts or derivatives, does not include oil*

Property of Brinker International - Confidential

Alcohol e.g. wine and spirits

Animal Product excluding dairy and egg ingredients: Any product that is derived from the body of animals or seafood (e.g. chicken fat, gelatin, and cheese rennet).

Artificial Colors

Artificial Flavors

Artificial Preservatives

Natural e.g. no added color, artificial flavors or synthetic substances1

* Oil that has been highly refined that is—has undergone purifying, bleaching and deodorizing can be considered free of allergenic proteins according to FDA’s Food Allergen Labeling and Consumer Protection Act of 2004''. 1 “U.S. Food and Drug Administration” What is the Meaning of ‘Natural’ on the Label of Food?” FDA, 8

June 2015. Web. 13 July 2015. http://www.fda.gov/aboutfda/transparency/basics/ucm214868.htm>

TEXT ONLY: DO NOT INSERT IMAGE

INGREDIENTS:

NUTRITION DATA GENERATED BY: Genesis R&D SQL by ESHA □ Internal or 3rd Party Laboratory Testing □ USDA Nutrient Database for Standard Reference □ Other □ Explain _________