-2318.pdf

CONTRACT REPAIR SCREENING ANALYSIS WORKSHEET

PART I (To be completed by PMS Seller)

1. FORM INITIATION DATE

31 AUG 2021

2. FORM PRIORITY

3. NSN

6220014572318FW

4. PART NUMBER

711140-8

5. PART NUMBER CAGE CODE

19623

6. NOUN

LIGHT ASSEMBLY,INDI

7. ANNUAL REPAIR

QUANTITY

8. LATEST REPAIR COST

$9,000.0000

9. ANNUAL REPAIR

BUDGET VALUE

$27,000.00

10. FORECAST UNIT

PRICE

$153,210.9500

11. ERRC

T

12. WEAPON SYSTEM

B-2

13. END ITEM APPLICATION

14. HISTORY

DOES ORGANIC REPAIR OR DMISA REPAIR CAPABILITY CURRENTLY EXIST? X NO YES (if yes, specify SOR)

HAS THE ITEM PREVIOUSLY BEEN CONTRACT REPAIRED?

IF YES, COMPLETE TABLE BELOW FOR LAST 5 YEARS (not to exceed last 3 contracts)

NO X YES

SOURCE NAME CAGE CONTRACT NUMBER AWARD DATE

SYMETRICS INDUSTRIES, LLC 14 JUN 202122830 FA811721F0150

SYMETRICS INDUSTRIES, LLC 10 MAR 202122830 FA811721F0092

SYMETRICS INDUSTRIES, LLC 28 SEP 202022830 FA811720F0256

SYMETRICS INDUSTRIES, LLC 10 JUN 201922830 FA811719F0106

SYMETRICS INDUSTRIES, LLC 06 SEP 201822830 FA811718F0148

15. PMS SELLER NAME

Masoner, Robert C

CODE OFFICE SYMBOL

422 SCMS / GUMC

PHONE

405-622-7304

COMPLETION DATE

31 AUG 2021

PART II (To be completed by Equipment Specialist)

16. TECHNICAL ORDERS REQUIRED X NO YES (annotate required data and availability on RDL) UNKNOWN

17. OTHER SPECIFICATIONS / SPECIAL REPAIR CRITERIA REQUIRED X NO YES (annotate required data and availability on RDL) UNKNOWN

18. THE DATA LISTED IN RDL COMPLETED SPECIFIES THE REPAIR REQUIREMENTS OR

X ADDITIONAL DATA IS REQUIRED (Coordinate with the engineer and screening office to determine information required. Document in Block 33)

19. SPECIAL TOOL / SPECIAL TEST EQUIPMENT IS NOT REQUIRED REQUIRED X REQUIRED BUT NOT AVAILABLE

SPECIAL FACILITIES ARE NOT REQUIRED X REQUIRED

GOVERNMENT FURNISHED MATERIAL IS NOT REQUIRED X REQUIRED REQUIRED BUT NOT AVAILABLE

20. EQUIPMENT SPECIALIST NAME

Standlee, Rodney

CODE

E3

OFFICE SYMBOL

422 SCMS / GUME

PHONE

405-582-5311

COMPLETION DATE

13 SEP 2021

PART III (To be completed by Screening Technician if applicable)

21. REQUESTED ENGINEERING DATA

LISTED AND ANNOTATED ON RDL X NO DATA

22. SCREENING TECHNICIAN REMARKS

23. SCREENING TECHNICIAN NAME CODE OFFICE SYMBOL PHONE COMPLETION DATE

PART IV (To be completed by the Engineer)

24. CRITICAL SAFETY ITEM

X NO YES

25. CAN THIS ITEM BE COMMERCIALLY

OVERHAULED / REPAIRED (FAR Part 12)

X NO YES

26. PRECONTRACT QUALIFICATION

REQUIRED

X NO YES (JQR/QR, SQS, Waiver)

27. RDL REQUIRED FOR

SOLICITATION

X NO YES

28. RMC / RMSC CODE

R3 / D

29. RMC / RMSC EXPIRATION DATE

06 JUL 2026

30. REASON FOR OTHER THAN G CODE AND ACTION TO REMEDY

Requirement that all faults must be identifiable and repairable for this item restricts the repair source to those who have complete data for repair. Based on a review of the data, only the official licensed vendor, Extant Aerospace, meets this requirement at this time.

31. APPROVED / POTENTIAL SOURCES

CAGE

CODE DATE APPROVED

Page 1 of 2AFMC FORM 762, 20060201, V1 Version 5Generated by PRPS using Jasper Reports on 11 Jan 2022

CONTRACT REPAIR SCREENING ANALYSIS WORKSHEET

31. APPROVED / POTENTIAL SOURCES

CAGE

CODE DATE APPROVED

Extant Aerospace 22830 22 JUL 2016

32. ENGINEER NAME

Johnson, Mark W

CODE

N/A

OFFICE SYMBOL

422 SCMS / GUEA

PHONE

405-582-5635

COMPLETION DATE

13 SEP 2021

PART V (Miscellaneous, if needed)

33. REMARKS (Remarks require Functional Responsibility / Name / Office Symbol / Phone)

USER TYPE: Equipment Specialist NAME: Standlee, Rodney DATE: 22 JUL 2016

ORG / OFFICE SYMBOL: 422 SCMS / GUME COMMERCIAL PHONE: 405-582-5311 DSN PHONE: 852-5311

See Appendix B for GFE listing. Additional special tools/test equipment is required but not available.

USER TYPE: Equipment Specialist NAME: West, Vincent E DATE: 06 JUL 2012

ORG / OFFICE SYMBOL: 422 SCMS / GUME COMMERCIAL PHONE: 405-734-8342 DSN PHONE: 884-8342

Physical Dimensions: Length 2.85 inches, Width 7.875 inches, Depth 12.53 inches, Weight 7.5 pounds.

Page 2 of 2AFMC FORM 762, 20060201, V1 Version 5Generated by PRPS using Jasper Reports on 11 Jan 2022