21Q0002_Exhibit_A.pdf

CONTRACT __________________

PRINTED (DATE CREATED) PAGE _______

EXHIBIT A

(ADP DD FORM 1423 (MECHANIZED EQUIVALENT) PER DAR CLAUSE 16-815)

CONTRACT DATA REQUIREMENTS LIST

SYSTEM/ITEM: BULK NITROGEN S/S 59 CATEGORY ____________

ITEM NO CONTRACTOR

01 SEQ NO A001

02 DATA DESC MATERIAL SAFETY DATA SHEETS

03 SUBTITLE FED-STD-313D

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.2.1

06 TECH OFFICE 106

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 106.1 1/

15 TOTAL 2

16 REMARKS CONTRACTOR TO PREPARE AND SUBMIT MATERIAL SAFETY DATA

SHEETS (MSDS) AS SPECIFIED BY FED-STD-313 REV D DATED APRIL 3 1996. THE MSDS SHALL

ALSO BE IDENTIFIED BY THE STOCK NUMBER 6830 00-285-4769.

SEQ. NO. A001

PREPARED BY ________________________________________________ DATE__________________ APPROVED BY ________________________________________________ DATE__________________

DD FORM 1423

PRINTED (DATE CREATED) PAGE _______

(ADP DD FORM 1423 (MECHANIZED EQUIVALENT) PER DAR CLAUSE 16-815)

CONTRACT DATA REQUIREMENTS LIST

SYSTEM/ITEM: BULK NITROGEN S/S 59 CATEGORY ____________

ITEM NO CONTRACTOR

01 SEQ NO A002

02 DATA DESC CERTIFICATE OF COMPLIANCE

03 SUBTITLE

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.2.2

06 TECH OFFICE 2380

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM PRIOR TO INITIAL SHIPMENT

13 DATE SUB SUBM

14 DISTRIBUTION 410 1/

15 TOTAL 2

16 REMARKS CONTRACTOR TO SUBMIT THE CERTIFICATE OF COMPLIANCE TO

SHOP 99 REPRESENTATIVE AT THE COMPLETION OF THE DELIVERY. (FILLING OF MULTIPLE

SHIPYARD TANKS FROM THE SAME SUPPLY TRUCK IS CONSIDERED A DELIVERY.

SEQ. NO. A002

PREPARED BY ________________________________________________ DATE__________________ APPROVED BY ________________________________________________ DATE__________________

DD FORM 1423

PRINTED (DATE CREATED) PAGE _______

CONTRACT/SOLICITATION ________________________________________________________________

ITEM ___________________________________________ (DATE FOR ITEM) ___________________

REQUIRED CERTIFICATION

A. CERTIFICATION SHALL BE SUPPLIED WITH EACH SHIPMENT OF MATERIAL.

CERTIFICATION (CERTIFICATE OF COMPLIANCE) SHALL BE SUPPLIED AS OUTLINED IN

PARAGRAPH B. THE VENDOR IS LIABLE FOR CONDUCTING ALL TESTS, ANALYSES,

INSPECTIONS, AND EXAMINATIONS, ETC., AS SPECIFIED BY THE CONTRACT AND

SPECIFICATIONS WHETHER CERTIFICATIONS ARE REQUIRED OR NOT.

CERTIFICATE OF COMPLIANCE (PROVIDE THE FOLLOWING VERBATIM STATEMENT OR

COMPLETE THE OPTIONAL FORM AT THE END OF THIS PART)

"I ATTEST ALL ITEMS FURNISHED ON THIS CONTRACT ARE IN FULL COMPLIANCE WITH

ALL CONTRACT REQUIREMENTS".

B. CERTIFICATION SHALL BE SUPPLIED PER THE FOLLOWING INSTRUCTIONS:

1. THE CERTIFICATION OF COMPLIANCE SHALL CONTAIN THE SIGNATURE AND TITLE OF

THE VENDOR OFFICIAL DESIGNATED RESPONSIBLE FOR QUALITY ASSURANCE.

2. THE MATERIAL IDENTIFICATION (E.G. LOT, BATCH, PART #, ETC.) SHALL BE INCLUDED

ON THE CERTIFICATE OF COMPLIANCE.

PRINTED (DATE CREATED) PAGE _______

CERTIFICATE OF COMPLIANCE

COMPANY NAME

MATERIL IDENTIFICATION (COMPLETE APPLICABLE ITEMS)

CONTRACT NO. ______________ ORDER NO. ________________ ITEM NO. ____________________ NATIONAL/LOCAL STOCK NO. NSN/LSN ____________________________________________________ MANUFACTURER’S PART NO. _____________________________________________________________ MANUFACTURER’S SERIAL NO. ___________________________________________________________ DRAWING AND PIECE NO. _________________________________________________________________

MANUFACTURER’S LOT/HEAT NOS. AS MARKED ON THE MATERIAL _________________________

ALL INSPECTIONS AND TEST REPORTS REQUIRED BY ATTACHMENT I TO EXHIBIT A (DD FORM

1423) FOR TRACEABILITY TO EACH CONTRACT ITEM MUST ACCOMPANY THIS SIGNED

STATEMENT:

THE INSPECTION AND TEST REPORTS (AS APPLICABLE) PROVIDED REPRESENT THE ACTUAL

ATTRIBUTES OF THE ITEMS FURNISHED ON THIS CONTRACT AND INDICATE FULL

COMPLIANCE WITH ALL CONTRACT REQUIREMENTS. I ATTEST ALL ITEMS FURNISHED ON

THIS CONTRACT ARE IN FULL COMPLIANCE WITH ALL CONTRACT REQUIREMENTS.

SIGNATURE ___________________________________________________ DATE _______________

QUALITY ASSURANCE OFFICIAL