4013881_SMW_REPORT.pdf
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- Solicitation number
- FA812126R0018
About this file
This is an Air Force Materiel Command (AFMC) Surplus Materiel Worksheet (AFMC Form 813) dated 23 September 2024 for evaluating the acceptability of surplus material to fulfill government procurement needs. The document pertains to National Stock Number (NSN) 2995014502816NZ, Part Number 4083931, manufactured by CAGE code 77445, for application in the F100 CENC system. The request was initiated by Adam T. Swain at the 421 SCMS/GUMAD office (405-734-1759) to determine whether available surplus materiel can be considered for procurement in accordance with AFMC FAR Supplement Part 5352.
The evaluation, completed by Ronald P. Van Velsor on 24 September 2024, marks the part as acceptable for consideration in the Government Surplus category (New/Unused classification). Approved evaluation criteria include Part Number and Manufacturer Verification (MFG 77445, P/N 4083931), Prior Government Ownership confirmation, 100% End Item Inspection, Test and Verification using Tech Order 2J-F100-24, and Verifiable Dimensions (Design Activity 77445, Drawing Number 4083931). Surplus offerors must complete and submit the "Required Information for Surplus Material Evaluation" form for Contracting Officer and Cognizant Engineer approval before acceptance. Critical acceptance requirements mandate that parts be in original unopened packages with correct labeling, show no packaging damage or corrosion evidence, and meet all specified criteria; rejected items will be returned to the vendor at no government cost.
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Text version
SURPLUS MATERIEL WORKSHEET
DATE
23 SEP 2024
I. REQUEST FOR EVALUATION
NSN
2995014502816NZ
PART NUMBER
4083931
CAGE
77445
APPLICATION
F100 CENC
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 4083931P/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 2J-F100-24
VERIFIABLE DIMENSION (AFMCFARS 5352.211-9012) DESIGN ACTIVITY 77445
DRAWING NUMBER 4083931
LOCATION OF INSPECTION TESTING (AFMCFARS 5352.211-9015)
INITIAL ACCEPTABILITY ITEMS (AFMCFARS 5352.211-9014) A QUANTITY OF ITEMS WILL BE TESTED FOR INITIAL ACCEPTANCE
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)
Van Velsor, Ronald PNAME: 24 SEP 2024DATE:
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
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
Van Velsor, Ronald P
OFFICE SYMBOL
AFLCMC / LPSBE
PHONE
405-734-5811 / 884-5811
COMPLETE DATE
24 SEP 2024
Page 1 of 2AFMC FORM 813, 20000323 (IMT-V1) Version 14Generated by PRPS using Jasper Reports on 30 Apr 2026
SURPLUS MATERIEL WORKSHEET
DATE
23 SEP 2024
SIGNATURE
//SIGNED// Van Velsor, Ronald P
USER TYPE
DEACTIVATED
SIGNATURE DATE
24 SEP 2024
Page 2 of 2AFMC FORM 813, 20000323 (IMT-V1) Version 14Generated by PRPS using Jasper Reports on 30 Apr 2026
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