3392112_Section J-List of Attachment.PDF

RECOMMENDED QUALITY ASSURANCE PROVISIONS

AND SPECIAL INSPECTION REQUIREMENTS

1. PR / MIPR NUMBER

2. NATIONAL STOCK NUMBER

1680ND084618GWF

3. POINT OF INSPECTION

SOURCE DESTINATION

X

SEE DFARS 246.402

4. POINT OF ACCEPTANCE

SOURCE DESTINATION

X

5. ITEM MANAGER / PHONE

King, Jamiika C / 801-586-0915

6. EQUIPMENT SPEC / PHONE

Bertario, Lara / 801-777-7118

7. CONTRACT QUALITY REQUIREMENTS/SPECIAL INSPECTION REQUIREMENTS

CERTIFICATE OF CONFORMANCE

FAR 52.246-15

CONTRACT RESPONSIBILITY

FOR INSPECTION

FAR 52.246-1

X STANDARD INSPECTION

FAR 52.246-2,-3,-4,-5 OR -6

AS APPLICABLE TO CONTRACT

HIGHER LEVEL CONTRACT QUALITY REQUIREMENTS

COMMERCIAL ITEM INSPECTION

FAR 52.212-4

OTHER (Describe in Block 8)

8. REMARKS

8a. OZONE DEPLETING SUBSTANCES (ODS)

X STATEMENT

"I HAVE REVIEWED THE REQUIREMENT, INCLUDING AVAILABLE TECHNICAL DOCUMENTATION, AND BELIEVE THAT IT DOES NOT REQUIRE THE CONTRACTOR USE CLASS I OZONE DEPLETING SUBSTANCES (ODS) IDENTIFIED IN AIR FORCE POLICY, NOR IS IT WRITTEN SO THAT IT CAN

ONLY BE MET BY THE USE OF A CLASS I ODS."

WAIVER (SEE AF FARS 5323)

NOTE: Quality provisions as annotated hereon will not be downgraded without Technical Authority coordination. The Technical Authority must be notified if award selection is made to a new source using Acquisition Method Code (AMC) 3, 4, or 5.

9. QUALITY PRE-AWARD SURVEY

YES NEW SOURCE

PREVIOUS SOURCEX NO

AFMC PARTICIPATION

RECOMMENDED

10. CODES

A. I&A

B. CQR

C

11. SIGNATURE OF TECHNICAL AUTHORITY

King, Jamiika C

ORGANIZATION / SYMBOL

406 SCMS / GULAB

PHONE

801-586-0915 / 586-0915

DATE

06 DEC 2021

Page 1 of 1AFMC FORM 807, 20060111, V1 Version 1Generated by PRPS using Jasper Reports on 08 Dec 2021

11/30/21, 11:51 AM

E*1HIsI1i1

Record 115065 DashBoard - PNSSR

Total Days: 267

Document Identifier * + Depot Identifier * +? M&S FSCM Part Number * Unit of Issue * Quantity *

AOB Fordomesticshipmer FGZ v SS1977H EA 500

1-3 4-6 7 8-12 13-22 23-24 25-29

Demand SERV Fund Code Distribution Code Project Code DocumentNumber

ON SERV ON Requisitioner 44 45 52 53 54 56 57 59

FB 2029

Supp. Signal Priority* Req. Delivery Day Advice Code

30 31 32 35 Address

ON Date ON Serial 51 60 61

65 66

1166 X522 46 50 62 64 (Julran)

36 39 (Julian) 40-43 Blank Reject Code

67-80 65-66 (For Use By Supply Source Only)

Identification Data

1. Manufacturers Code and Part No. * 2. Manufacturer Name

5S1977H ZZZZZ

3. Manufacturers Catalog Identification 4. Mfg. Date 5. T.O. Number * Figure & Index *

5F5-428-4 14&8

6. Technical Manual Number 7. Name of Item Requested *

TRANSISTOR

8. Description of Item Requested * 8a. Color

TRANSISTOR

8b.Size

9. End Item Application * 9a. Source of Supply *

6130 01 059 9017 FGZ

9b. Make 9c. Model Number 9d. Series 9e.SeriallTail Weapon System: *

Number + F16

0111027 https://pnssrs.hill.af.mil/PNSSRSV2/DashBoard/lndex/115065 1/14

11/30/21, 11:51 AM

rctckm Sign (PIanneJ

DLA Aviation Review

LP Number P/LP Established Date

Record 115065 DashBoard - PNSSR

(Date Assigned) (Date Completed)

MX Back Order Clear Date

LP0072492 3/08/2021 6/15/2021

DLA Location Clerk Code Stock Obsolete/No [ Clear Signature (CSS) worldwide assets

DLA Aviation - E4 Signed By:

Spendlove, Sharrie Location: hill

(Click for Signature Details)

Clear Signature (PNO) ] Date Signed

Signed By: 3/10/2021

SALAMANCA,

JESSICA Location: Hill

AFB

(Click for Signature Details)

406th Technical Review I Remarks [_ Add 406 SCMS ES Remarks

Author: KING, JAM IlKA RAE

Date: 11130/2021 11:51:03AM Remark: PR reassigned to Jamiika

[Edit

Author: MILLER, SHERRY Date: 11/24/2021 7:47:34 AM

Remark: Received ES response "Yes, 15576-2 is an alternate PIN. Semicoa part# 15576-2 = NSN 5961-00-333-9652. VIR, Bertario Lara Equipment

Specialist 416th SCMS/ GUMAC DSN: 777-7118'

Clear Signature (406E5)_J Date Signed

Signed By: 3/10/2021

SALAMANCA, JESSICA Location: Hill AFE

PNCR 2A. - To be completed by 3/8/2021 10:08:56, 12/2/2021 12:28:31 appropriate Equipment Specialist (ES) Entry Date Suspense Date Get Well Date ?

https://pnssrs.hilLaf.mil/PNSSRSV2/DashBoard/lndex/115065 3/14

11/30/21, 11:51 AM Record 115065 DashBoard - PNSSR

PNCR 3A. ES must complete the following if Local Purchase or Depot Manufacture is recommended

A. Next Higher Assembly: B. Recommended FSC C. Recommended MMAC D. Realistic Est. Unit E. Prime Ctr/Mfg Cage:

Price:

0.00

F. Recommended Source(s) & Cage:

G. Item Description:

[Clear Signature (ES) j ES Org: ES Code:

Signed By: H1LL416SCMS/GUMA v HHJ V

LARA, BERTARIO Location: Hill AFB

Record Number

115065 Part Number

SS1877H

Document Number

FB20291166X522

Completion/Cancellation Date: ?

ND Number: AO/Alternate AO Reviewer: AO Date Assigned:

1560N0084572GWF JESSICA SALAMANCA (Hill 10/19/2021

Sig nature

Signed By:

SALAMANCA, JESSICA Location:

Hill AFB

GPCIPR/206 Specialist: GPCIPR/206 Date Assigned: Clear/Cancel IC Date

JAMIIKA RAE KING (Hill AFE V 10/19/2021 https://pnssrs.hill.af.mil/PNSSRSV2/Dash8oard/Index/115065 5/14

Page: 1 ffiilLuai;] 333 McCORMICK AVENUE

COSTA MESA, CA 92626

Phone: (714) 979-1900 Fax: (714) 557-4541

Contact: Tony Kazmakites Voice: (914) 474-4224

CUSTOMER:

DLA LAND AND MARITIME

P0 BOX 182317

COLUMBUS, OH 43218-2317

USA

Phone: (614) 692-9748

*1.111.)fII [']

REV NO:

QUOTE NUMBER: 0010943

QUOTE DATE: 6/2/202 1

EXPIRE DATE: 8/1/202 1

CUSTOMER QUOTE: NSN 5961-00-333-9652

CONFIRM TO: Bert Lara

Semicoa is pleased to provide the following quotation:

Delivery dates quoted herein from Semicoa Stock On Hand are at time of quote. Non-Inventory items for this part type are subject to standard lead time.

Shipping Terms: Incoterms 2020 EXW (EXWORKS)

Payment Terms are Net 30 days upon credit approval and are subject to prior sale. All SCD custom parts, delivery of +/- 10% on the ordered quantity in general is considered standard. All orders placed at Semicoa may be subject to a cancellation / change handling charge.

Please follow this link to view and/or print the Semicoa Standard Term and conditions: http://semicoa.com/Semicoa_Terms..and_Conditions.htm

Thank you for the opportunity to earn your business.

D143C ESTABLISH/CHANGE ND/K CMD 12/01/2 1

REF NR: 11576-2 CAGE: 34156

CONTROL NR: F1G58088 NDJC: A

FSC: 1680 NuN: N0084618G MMAC: WF WAIVER NBR:

PM IC: A WAIVER EXP:

ADPEC: 0 RAD CD:

SOS: FGZ ESC: DH

AAC:J MDC:DXG

SHELF LIFE CD: 0 SMGC:

CIIC: U IUID: 0 PVC: E

DEMILCD:A FAA: ESDC:

FUND CD: SF SERIAL REPORT: N

UNITOF ISSUE: EA

ERRC: N

QUP: 1

BUDGET CD: 8 K PHRASE:

UNIT PRICE: 27.11

AF IM: SU

NOMEN: TRANSISTOR APPL DATA: F16

OPTION (PHR,REF,RMKS,EDIT,D043A,?,CANC,COOR,END) EDIT

S

ALERT! This entity is only available FOR OFFICIAL USE ONLY.

DUNS Unique Entity ID

117595815

Purpose of Registration

All Awards

Physical Address 333 Mccormick AVE

Costa Mesa, California 92626-3422

United States

SAM Unique Entity ID

SKNFJARLK7JB

Registration Status

Active

Mailing Address

333 Mccormick AVE

Costa Mesa, California 92626-3422

United States

CAGE I NCAGE

34156

Expiration Date

Jan 30, 2022

Doing Business as Semicoa

Congressional District

California 48

Registration Dates

Activation Date Aug 21, 2020

Division Name

(blank)

State I Country of Incorporation

California / United States

Submission Date Aug 3, 2020

Division Number (blank)

URL

https:/Iwww.semicoa.com/

Initial Registration Date

Jul 16, 2020

Entity Dates

Entity Start Date Fiscal Year End Close Date

May 9, 2014 Jun30

Immediate Owner

CAGE Legal Business Name

50486 OSI OPTOELECTRONICS, INC.

Highest Level Owner

CAGE Legal Business Name

(blank) (blank)

Executive Compensation

Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of

P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions.

Proceedings Questions

Registrants in the System for Award Management (SAM) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9, or

2.C.F.R. 200 Appendix XII. Their responses are not displayed in SAM. They are sent to FAPIIS.gov for display as applicable. Maintaining an active registration in SAM demonstrates the registrant responded to the proceedings questions.

I authorize my entity's non-sensitive information to be displayed in SAM public search results:

Yes

Business Types

Entity Structure

Corporate Entity (Not Tax Exempt)

Entity Type

Business or Organization

Organization Factors

Manufacturer of Goods

Profit Structure

For Profit Organization

PACKAGING REQUIREMENTS

PURCHASE INSTRUMENT NUMBER: FD20202200351-00 VERSION: 1

MIL-STD 129 REVISION: R MIL-STD 2073-1 REVISION: E

THE FOLLOWING STATEMENT IS IN COMPLIANCE WITH THE UNITED NATIONS-IMPLEMENTED RESTRICTIONS ON WOOD PACKAGING MATERIAL (WPM). THIS REQUIREMENT IS SPECIFICALLY CONCERNED WITH INVASIVE SPECIES SUCH AS THE PINEWOOD NEMATODE. WPM IS DEFINED AS WOOD PALLETS, SKIDS, LOAD BOARDS, PALLET COLLARS, WOODEN BOXES, REELS, DUNNAGE, CRATES, FRAMES, AND CLEATS. THE STATEMENT BELOW CITES THE REQUIREMENTS IN DETAIL AND COVERS LUMBER FOR BUILDING CONTAINERS AND PALLETS USED FOR DELIVERIES RESULTING IN SHIPMENTS WORLDWIDE (DIRECT, OR THROUGH AIR LOGISTICS CENTERS (ALC), CONTAINER CONSOLIDATION POINTS (CCP), OR OTHER BASES). WOODEN LUMBER, WOODEN

PALLET AND PACKAGING/CONTAINER STATEMENT:

ALL WOODEN LUMBER, WOODEN PALLET'S, AND WOODEN CONTAINERS PRODUCED ENTIRELY OR IN PART OF WOOD PACKING MATERIAL (WPM) SHALL BE CONSTRUCTED FROM DEBARKED WOOD IN ADDITION TO THE APPLICATION OF HEAT-TREATED (HT) MATERIAL (HT TO 56 DEGREES CENTIGRADE OR 133 DEGREES FAHRENHEIT FOR 30 MINUTES). CERTIFICATION/MARKING IS REQUIRED BY AN ACCREDITED AGENCY RECOGNIZED BY THE AMERICAN LUMBER STANDARDS COMMITTEE (ALSC). FOR REFERENCE DOCUMENTATION, SEE LATEST REVISION OF "INTERNATIONAL STANDARDS FOR PHYTOSANITARY MEASURES" (ISPM)NO.15), "REGULATION OF WOOD PACKAGING MATERIAL IN INTERNATIONAL TRADE."

PACRN: PACKAGING REQUIREMENT: PRESERVATION LEVEL: PACKAGING LEVEL: SPI: SPI REV: SPI DATE:

AAA Specification Commercial Packaging (ASTM-D-3951) COM

ITEM(S):

1680ND084618GWF

CODED DATA:

QUP ICQ

PRES

METH CD

PRES

MTL

WRAP

MTL

CUSH

DUNN CT

UNIT

CONT

INT

CONT UCL

SPEC

MKG

UNIT PACK

WEIGHT

LENGTH

WIDTH

DEPTH

CUBE OPI

ADDITIONAL PACKAGING AND CONTAINER MARKING REQUIREMENTS:

SUPPLEMENTAL PACKAGING INSTRUCTION TEXT:

VENDOR PACKAGING INSTRUCTIONS:

Shipping Container Marking Shipping containers shall be marked meeting the following criteria: (a) MIL-STD-129, Standard Practice for Military Marking. (b) Additional marking and/or bar coding requirements exceeding those of MIL-STD-129 (e.g., unit serial numbers, original equipment manufacturers (OEM) name, or OEM model number, as specified on the AFMC Form 158.

Specification Commercial Packaging (ASTM D3951)

(a) Items shall be packaged in accordance with American Society for Testing and Materials (ASTM) Specification D3951-98, Standard Practice for Commercial Packaging. Individual shipments exceeding 150 pounds, 108 inches in length, or 130 inches in girth plus length shall be packaged on skidded crates or palletized to allow handling by forklift. (b) The exterior container shall be marked (readable from 24 inches): "ASTM D3951 - NOT FOR OUTSIDE

STORAGE."

ORGANIZATION / OFFICE SYMBOL:

406 SCMS / GULAA

PACKAGING SPECIALIST:

Talbot, Bradley J

PHONE NUMBER:

801-777-8840 / 777-8840

SIGNATURE:

//SIGNED//Talbot, Bradley J

DATE:

21340 - 06 DEC 2021

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TRANSPORTATION DATA FOR SOLICITATIONS

COMMODITY: See Continuation

PURCHASE INSTRUMENT NUMBER:

FD20202200351-00

DATE INITIATED:

STOCK NUMBER: See Continuation

X ORIGIN DESTINATION OTHER DATA / FIRST ARTICLE F.O.B. DESTINATION(Specify)

F.O.B. TERMS RECOMMENDED AS BEST SUITED FOR THIS PROCUREMENT

TRANSPORTATION PROVISIONS / CLAUSES FAR CITATION

F.O.B. Origin 52.247-29 Freight Classification Description 52.247-53 Contact DCMA Transportation Contact DCMA Transportation on ALL "DCMA Administered" contracts prior to shipment for shipping instructions using the DCMA Shipment Instruction Request (SIR) eTool System, at http://www.dcma.mil <http://www.dcma.mil/> for ALL FOB:

Origin, Foreign Military Sales (FMS), and FOB: Destination OCONUS/Export movements to obtain the appropriate DOD regulatory clearances, shipping documentation and instructions from your cognizant DCMA Transportation Office. If you are new to DCMA, and do not already have a SIR eTool account, you will first need to request an account via DCMA External Web Access Management (EWAM) application which can be accessed at http://www.dcma.mil. If you need additional assistance, email DCMA Transportation Group at: Transportation.Division@dcma.mil. Do not move any freight to a water or aerial port prior to contacting DCMA or it will become frustrated. Failure to contact the responsible DCMA may result in vendor incurring additional expenditures.

Vendor Transportation Instructions

IAW BASIC CONTRACT FD20202200351-00

TACRN:

AAA

TRANSPORTATION FUNDS INFORMATION:

Purchase Instrument Line LOA: 97X4930.FC04 642 47GH 15F16Z 01N000 00000 NDACNP 503000 F03000 FSR: 001679 PSR: K27970

First Destination Transportation Account Code: FRS3

Miscellaneous Obligation / Reimbursement Document:

Second Destination Transportation Account Code:

FMS LOA:

Additional Funding Information:

ITEM / SHIP TO(s):

NSN / Pseudo NSN: 1680ND084618GWF

Purchase Instrument Line Item Number: 0001

Ship to (DoDAAC / MAPAC): FB2029

Mark For: CODE 09

Ship To (Address): FB2029 OO ALC DDHU CNTRL RCV

5851 F AVE BLDG 849W

HILL AFB UT 84056

84056 - 4056

USA

WPOD:

APOD:

BBP / CCP:

RIC: 1

Requisition Number:

Supplemental Address:

FMS Case:

CP 385 519 8898

Ship To (Remarks):

EVALUATION OF PORT BID OR PROPOSAL:

SOLICITATION DATA NOTES:

OTHER TRANSPORTATION DATA:

NAME

Hogan, Darrick D

ORGANIZATION / OFFICE

SYMBOL

406 SCMS / GULAA

COMMERCIAL / DSN

PHONE

478-327-3489 / 497-3489

SIGNATURE

//SIGNED//Hogan, Darrick D

DATE

Page 1 of 1DD FORM 1653 Version 1Generated by PRPS using Jasper Reports on 08 Dec 2021

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5. DOC DATE 6. NMFC 7. FRT RATE 8. TYPE CARGO 9. PS

10. QTY. REC'D 11.UP 12. UNIT WEIGHT 13. UNIT CUBE 14. UFC 15. SL

16. FREIGHT CLASSIFICATION NOMENCLATURE

18. TY CONT 19. NO CONT 20. TOTAL WEIGHT 21. TOTAL CUBE

22. RECEIVED BY 23. DATE RECEIVED

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10. QTY. REC'D 11.UP 12. UNIT WEIGHT 13. UNIT CUBE 14. UFC 15. SL

16. FREIGHT CLASSIFICATION NOMENCLATURE

18. TY CONT 19. NO CONT 20. TOTAL WEIGHT 21. TOTAL CUBE

22. RECEIVED BY 23. DATE RECEIVED

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TPCents: 00

ShipFrom:

ShipTo: FB2029

MarkFor:

DocDate:

NMFC:

FRTRate:

TypeCargo:

PS:

QtyRecd:

UP:

UnitWeight:

UnitCube:

UFC:

SI:

FreightClassNomen:

ItemNomen: Transistor

TYCount:

NOCount:

TotalWeight:

TotalCube:

RecdBy:

DateRecd:

DocNum: FB20291166X522

NSNa:

NSNb: 1680ND084618GXM

DocIden: D6A

MandS:

UnitIss: EA

Quant: 0500

SER:

SupAdd:

Sig: D

Fund: 64

Distribution: 001

Project:

Pri: 3

RecdDelDate:

Adv: 2B

Ri:

OP:

Cond: A

MGT:

UPDollars: 0

UPCents: 00

RICUIQTY:

AddData: Attention: Dear John Bay DDHU Hill Facility Central Receiving Bldg 849 W 5851 F Ave Hill Air Force Base, UT 84056-5713 Note: (Please include attached shipping document (1348-1A) with the shipping documents being attached to box or shipping container or envelope)

ClearButton:

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