3307534_SMW_REPORT.pdf

SURPLUS MATERIEL WORKSHEET

DATE

11 AUG 2021

I. REQUEST FOR EVALUATION

NSN

3040012677735NZ

PART NUMBER

4067419

CAGE

77445

APPLICATION

F100-PW-220/229

IMS

Swain, Adam T

OFFICE SYMBOL

421 SCMS / GUMAD

PHONE

405-734-1759

SURPLUS MATERIEL MAY BE AVAILABLE TO FULFILL THE GOVERNMENT'S NEEDS FOR THIS ITEM. AS A RESULT, AN EVALUATION MUST BE PERFORMED

IAW AFMC FAR SUPPLEMENT PART 5352.

THE EVALUATION ON THIS ITEM INDICATES SURPLUS MATERIEL WILL BE CONSIDERED IN THE FOLLOWING TYPES / CATEGORIES

II. EVALUATION CRITERIA (For types/categories deemed acceptable)

ACCEPT-

ABLE (Y/N)

P/N AND

MFG

VERIFI-

CATION

PRIOR

GOV'T

OWNER-

SHIP

100% END

ITEM

INSPECT

TEST AND

VERIFI-

CATION

VERIFI-

ABLE

DIMEN-

SIONS

LOCATION

INSPEC-

TION

TESTING

INITIAL

ACCEPT-

ABILITY

ITEMS

OVERHAUL

AND

CERTIFI-

CATION

OTHER

(Explain in Remarks)

Y X X X

N

N

N

N

N

N

N

G O V T

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

C O M M L

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

SURPLUS EVALUATION CRITERIA (If Section 11a. indicates surplus materiel may be considered). (Fill in blanks as appropriate)

PART NUMBER VERIFICATION 77445(AFMCFARS 5352.211-9011) MFG 4067419P/N

PRIOR GOVERNMENT OWNERSHIP (AFMCFARS 5352.211-9015)

100% END ITEM INSPECTION (AFMCFARS 5352.211-9017)

TEST AND VERIFICATION (AFMCFARS 5352.211-9013) TECH ORDER NUMBER N/A

VERIFIABLE DIMENSION (AFMCFARS 5352.211-9012) DESIGN ACTIVITY 77445

DRAWING NUMBER 4067419

LOCATION OF INSPECTION TESTING (AFMCFARS 5352.211-9015)

INITIAL ACCEPTABILITY ITEMS 0(AFMCFARS 5352.211-9014) A QUANTITY OF ITEMS WILL BE TESTED FOR INITIAL ACCEPTANCE

N/A

TEST WILL BE CONDUCTED USING THE FOLLOWING CRITERIA (and location of testing)

OVERHAUL AND CERTIFICATION (AFMCFARS 5352.211-9010)

N/A

OTHER SPECIAL REQUIREMENTS (Explain)

Fabrie, Cyle RNAME: 17 AUG 2021DATE:

Surplus Offerors shall complete and return the "Required Information for Surplus Material Evaluation" form, attached, in accordance with FAR 11.302(b). The Contracting Officer shall obtain approval/ disapproval from the Cognizant Engineer based on the completed form returned by the surplus offeror prior to accepting or rejecting the surplus offer.

REMARKS

JUSTIFICATION FOR UNACCEPTABLE SURPLUS MATERIEL

Justification:

Surplus items that do not conform to all of the above requirements, including those in the REMARKS section, are not acceptable. Misrepresentation of any item by the offeror shall be cause for rejection and return of all items to the offeror at no cost to the government.

- The part shall be in the original unopened package, labeled with the correct part number and NSN.

- Misrepresentation of any item by the surplus vendor shall be cause for rejection.

- Damage to packaging shall be cause for rejection as these parts are susceptible to corrosion.

- Any evidence of corrosion shall be cause for rejection of part.

- Rejected parts will be returned to the vendor at no cost to the government.

EVALUATOR

Fabrie, Cyle R

OFFICE SYMBOL

AFLCMC / LPSEA1

PHONE

405-734-8704 / 884-8704

COMPLETE DATE

17 AUG 2021

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SURPLUS MATERIEL WORKSHEET

DATE

11 AUG 2021

SIGNATURE

//SIGNED// Fabrie, Cyle R

USER TYPE

Engineer

SIGNATURE DATE

17 AUG 2021

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