70Z03822QB2000001 - Attachment 2 - Statement of Work.docx.pdf

70Z03822QB2000001

Attachment 2

RADOME REPAIRS

STATEMENT OF WORK

1.0 SCOPE

The United States Coast Guard (USCG), Aviation Logistics Center (ALC), Short Range

Recovery (SRR) product line requires depot level repair for Radome, Part Number (P/N)

365A61-1675-01, NSN: 5841-01-HS1-7318, utilized on the MH-65 aircraft.

The Contractor shall inspect, repair, and test the radomes. Inspection, repair and testing shall be accomplished in accordance with (IAW) the Original Equipment Manufacturer (OEM), Airbus

Helicopters, France, United States (US) Navy, Naval Air Systems Command (NAVAIR)

Technical manual 01-1A-22 or Air Force Technical Manual (AFTO) 1-1-24 to ensure full compliance with performance standards. NAVAIR 01-1A-22 and AFTO 1-1-24 are also referred to as Scientific Technical Information (STINFO) Level C.

The repaired radomes and repaired radar windows shall be tested and certified to a Class B rating for transmission efficiency as outlined in the Radio Technical Commission for Aeronautics

(RTCA) DO-213. The Contractor is solely responsible for obtaining the RTCA DO-213.

Radomes will be shipped by the USCG to the Contractor via individually funded firm fixed price

(FFP) Task Orders (TO) to have equipment repaired, inspected, tested and returned to a Ready for Issue (RFI) condition. The Contract Line Item Numbers (CLINs), shown in the Schedule of

Supplies/Services for each contract period of performance represents the Government’s estimated quantities of radomes that are anticipated to be repaired for the base and subsequent option year CLINSs for each contract period of performance. CLINs for radome repair (as shown in the Schedule of Supplies/Services) has an established firm fixed repair price that will be used to issue fixed price TOs under the terms and conditions (T&C) of the contract. The radomes are

Serial Number (S/N) tracked.

The Contractor shall provide all parts, labor, tooling, test components and facilities necessary for performance. (Reference USCG Illustrated Parts Catalog CGTO 1H-65D-4-V3 53-53-60 Figure

1, Radome Installation). The Hinges (Right Hand – P/N 967-53-46-3 and Left Hand – P/N 967-

53-46-1) will be shipped with radome or provided by ALC. The USCG will provide the following hardware that is either locally manufactured by ALC and not commercially available to the Contractor: P/N: 967-53-46-3, Hinge, RH (if not provided with the Radome); P/N: 967-53-

46-1, Hinge, LH (if not provided with the Radome); P/N: 965-41-2-1, Bracket, Radome Latch

(Adjustable); P/N: 965-41-2-2, Bracket, Radome Latch (Adjustable); P/N: 965-555-4, Jumper, Bonding; P/N: 967-53-14 Radome Bonding Strip.

Radomes repaired and delivered to the Government shall be certified to be airworthy via a

Federal Aviation Administration (FAA) 8130 or EASA Form 1 and RFI for installation on the

USCG aircraft.

2.0 Technical Requirements

The Contractor shall be either a 1) FAA Approved Repair Facility or 2) equivalent European

Aviation Safety Agency (EASA) Approved Repair Facility and be currently certified in at least one of the following: AS9110 and/or National Aerospace and Defense Contractor Accreditation

Program (NADCAP).

2.1 Repair

The radome shall be repaired IAW inspection, repair and test criteria documents as defined in the

NAVAIR 01-1A-22 or AFTO 1-1-24. For the repair to the radar window area of the radomes assembly; the repaired radomes shall be tested and certified to a Class B rating for transmission efficiency as outlined in the Radio Technical Commission for Aeronautics (RTCA) DO-213.

2.2 Inspection

Once the component(s) are received, a visual and functional inspection will be completed to confirm the specific fault for which the component(s) are dispatched, as noted in the Significant

History Report (SCHR).

A DD Form 1577-2/1577-3, Unserviceable (Repairable) Tag-Material, or CG-1577-A (11-90), Unsatisfactory Report Tag, will be attached to each non-RFI item, describing faults. In the event the radome is not tagged with the reason for removal, contact the Contracting Officerz to obtain the reason for removal.

2.3 Inspection No Fault Found (NFF)

Radomes, which when tested indicate a “No Fault Found” (NFF) shall be thoroughly inspected to ensure they meet current minimum functional performance and test specifications as designated in the Statement of Work (SOW). The Contractor shall provide written notification of NFF to the Contracting officer. A TO Modification will be issued reducing the price from the repair price to the Test and Evaluation fee/NFF fee established in the Schedule of

Supplies/Services under CLIN 0002 (and subsequent option year CLINs). The Contractor shall include the applicable Component Repair Record (CRR) with the component when it is shipped back to the USCG.

2.4 Labor Rates

All Labor Rates specified in CLINS 0003 through 0004, and subsequent option year CLINS for each contract period of performance, shall be a fully burdened rate that includes all overhead, general and administrative (G&A) expenses, and profit.

2.5 Corrosion

USCG aircraft operate primarily around salt water, at low altitudes, and are subject to corrosion.

During inspection and functional test, the presence of corrosion in a component shall constitute reason for a more thorough disassembly and inspection. Should corrosion be found, disassembly shall be made to the extent necessary to remove corrosion from a part if it will not impair efficiency or safe operation of the part. Corrosion removal and treatment of affected areas will be accomplished IAW the FAA Advisory Circular AC 43-4A, dated 09/11/2018, Corrosion

Control for Aircraft (NAVAIR 01-1A-509, Series).

In the case where specifications do not exist or are not clear, the Contractor shall provide written notification to the Contracting Officer. Disposition instructions shall be provided via modifications to the applicable TO.

2.6 Environmental Requirements

All parts must be thoroughly cleaned IAW applicable FAA Advisory Circular 43-205, Guidance for Selecting Chemical Agents and Processes for De-painting and General Cleaning of Aircraft and Aviation Products to ensure they are as free as practicable of all hazardous dust to include hexavalent chromium, cadmium, lead, etc., prior to being returned to ALC. ALC may take random samples of parts to ensure they are free as practicable of all hazards. Information on these hazards can be found in Occupational Safety and Health Standards 1910.1025 (lead),

1910.1026 (Hexavalent Chromium) and 1910.1027 (Cadmium).

2.7 Warranty

The warranty provided with the Contractor’s quotation will be in effect for the duration of this contract. (Refer to Terms and Conditions FAR Clause 52.212-4.)

3.0 Replacement Parts

3.1 Systematically Replaced Parts

The firm fixed repair price established in the contract shall include all parts that are systematically replaced during repair as required.

3.2 Serviceable Parts

Parts of a component found to be in a serviceable condition as a result of inspection and functional testing may be reused. Missing parts or parts found to be defective shall be replaced with new, approved, parts that meet or exceed specifications and drawings, except as noted in the

SOW, section 3.4.

3.3 Beyond Economic Repair (BER)

In the event a radome is determined to be BER, the Contractor shall immediately notify the

Contracting Officer in writing for disposition instructions. The notification shall list the TO

Number, Line Item Number, National Stock Number (NSN), Part Number (PN), and Serial

Number (SN) with a brief description supporting the BER determination. The Contracting

Officer will provide disposition instructions via a TO Modification and the repair price will be adjusted downward to the Test and Evaluation Fee listed in CLIN 0002, and subsequent option year CLINS.

3.4 Government Furnished Property (GFP)

P/N: 967-53-46-3 Hinge, RH (if not provided with the Radome)

P/N: 967-53-46-1 Hinge, LH (if not provided with the Radome)

P/N: 965-41-2-1 Bracket, Radome Latch (Adjustable)

P/N: 965-41-2-2 Bracket, Radome Latch (Adjustable)

P/N: 965-555-4 Jumper, Bonding

P/N: 967-53-14 Radome Bonding Strip

In the event any of the above parts are needed for repair, the Contractor shall notify the contract specialist. The written request must reference the applicable to, line item and itemize specific parts needed.

4.0 Unusual Damage

4.1 General

The USCG anticipates that all components specified in the schedule will be shipped for repair within the FFP established in the resulting contract. Occasionally, components may be received in a condition outside the confines of the specification set forth in the SOW. Those components may be determined unusually damaged. In order to be determined unusually damaged, a component must be received for routine repair and upon evaluation any one of the following conditions are discovered:

Obvious misuse

Cannibalization

Crash Damage

Acts of God

Only components meeting one or more of the above criteria may be considered as Unusually

Damaged. All other components shall be repaired IAW the fixed repair prices established in the

Schedule of Supplies/Services.

4.1.1 Unusual Damage Reporting Requirements

When a component is processed for unusual damage evaluation, the Contractor shall immediately notify the Contracting Office in writing. The Government may request the

Contractor to submit an inspection condition report, pictures of the damage, and a repair quote listing all parts and labor needed to return the component to satisfactory condition that meets specifications outlined in the SOW. The quote shall include the TO Number, line item number, NSN, PN, and SN of the component. The Labor Hour Rate shall be charged at the firm fixed

Labor Hour Rate established in the Schedule of Supplies/Services under CLIN 0003, and subsequent option year CLINSs for each contract period of performance. The Contractor’s delivery obligation shall stop from the date of notification that item has been determined to be a candidate for “Unusual Damage” evaluation. The delivery obligation will be specified in the TO

Modification and will apply only to those items specifically addressed by the modification under the original delivery date specified on the TO. The quote shall not include the work involved in the teardown and inspection, which will have already occurred, as this is covered by the FFP specified under CLIN 0001 and subsequent option year CLINs for each contract period of performance for the Inspection/NFF.

The Contracting Officer shall either initiate negotiations for a FFP with the Contractor or deny authorization for the repair based on information in the report and any other information which may be available. Upon mutual agreement as to price and delivery, a TO Modification will be issued authorizing the repair at the agreed upon terms. If repair is not desired, the Contracting

Officer will provide the Contractor with disposition instructions for the un-repaired item. In the event an item is returned to the USCG in a disassembled condition, the Contractor shall be entitled only to appropriate compensation at the Test and Evaluation Fee specified in the

Schedule of Supplies/Services under CLIN 0002 and subsequent option year CLINs under each contract period of performance.

5.0 Service Bulletins, Modifications and/or Engineering Change Proposals

During the life of the Contract a component may require incorporation of a Service Bulletin, a

Modification, or an Engineering Change Proposal. Either the Contractor or the Government may receive notice from the OEM or other source of a require change. When the Contractor received notice of a Service Bulletin, Modification and/or Engineering Change Proposal, the Contractor shall immediately notify the Contracting Office in writing and submit a FFP quote for an incremental charge to be assessed each time the Service Bulletin, Modification, and/or

Engineering Change Proposal is incorporated in a component. The same applies upon receiving written notice from the Contracting Officer of items requiring incorporation of a Service

Bulletin, Modification, and/or Engineering Change Proposal. The quote shall contain a list of materials, with associated prices, the number of labor hours required, turn-around-time needed to effect the Service Bulletin, Modification, and/or Engineering Change Proposal, and any impact on the contract delivery schedule. The labor rate shall be the labor rates in CLIN 0004 and subsequent option year CLINs for each contract period of performance. The incremental charge agreed to for incorporation of a Service Bulletin shall apply only to those components into which the Contractor incorporates a required Service Bulletin, not those into which the Service Bulletin has been previously incorporated. Upon mutual agreement of the incremental charge the

Contracting Officer will issue a Contract Modification and applicable TO Modification to reflect the change and the Service Bulletin shall be incorporated into each subsequent component received at the Contractor’s facility if said Service Bulletin has not already been incorporated.

The Contractor shall update the components data plate, if applicable, denoting the new part number, NSN, and/or modification number, and new SN if one is assigned. The contractor shall not incorporate Service Bulletins, Modifications, and/or Engineering Change Proposals prior to receiving a Contract Modification and applicable TO modification.

6.0 Repair Turn-Around-Time and Delivery

6.1 Turn-Around-Time

The Required turn-around-time is sixty (60) days. In no case shall delivery exceed sixty (60) days after receipt of material without written approval from a Contracting Officer authorizing a delivery extension. Earlier delivery is desired if there are no extra charges to the Government.

Turn-around-time is defined as beginning at the “time of receipt” of the radome at the

Contractor’s facility ending at the time of delivery to the USCG ALC, Elizabeth City, North

Carolina, 27909, unless GFM is deemed necessary for repair. In the event GFM is required, turn-around-time will be extended sixty (60) days following Contractor’s receipt of GFM.

6.2 Accelerated Turn-Around-Time and Delivery

Only the Contracting Officer may request and authorize an accelerated turn-around-time and delivery, if needed, by the Government for delivery to the USCG, ALC Receiving Department, Weeksville Road, Elizabeth City, NC 27909. In the event an accelerated turn-around-time and delivery is needed, which the Contractor can meet, the Contractor shall be entitled to compensation for additional labor hours and expedited freight costs necessary to complete performance earlier than the turn-around-time and delivery schedule established in the Contract.

After receiving a written request from the Contracting Officer for an accelerated turn-around-time and delivery the Contractor shall provide a written response within two (2) business days advising if an accelerated turn-around-time and delivery can be accomplished and include any additional costs necessary for the accelerated performance. Accelerated performance will be authorized in writing via a TO Modification. If the Contractor accelerates turn-around-time and delivery on its own initiative in order to meet the delivery schedule established in the contract

TO the additional costs are not recoverable from the Government.

6.3 Aircraft of Ground (AOG) Requirements

An Aircraft on the Ground (AOG) situation necessitates a special schedule and requires accelerated repair completion and expedited delivery to the applicable USCG Air Station. In the event an AOG status occurs as a result of a lack of any of the components specified in the schedule, the Contractor will be notified by the Government in writing in the AOG situation.

Upon notification from the USCG that an AOG situation exists, the Contractor shall make every effort to expedite the repair/modification and initiate shipment with seven (7) calendar days or less. The Contractor’s response shall provide 1) status of the component(s) needed to satisfy the

AOG condition that includes what USCG items in-house for repair are closets to completion under normal working conditions and 2) an estimate of the labor hours needed to accelerate repair completion. The accelerated repair work will be authorized via a TO Modification in conjunction with mutually agreed upon prices, delivery, and shipping cost reimbursement for next day deliver to the applicable USCG Air Station.

In the event of an AOG situation, the TO and applicable TO Line Item Number will be modified to reflect the USCG Air Station’s delivery address and the applicable USCG Requisition

Number. The Contractor shall be required to ensure the Requisition Number is included on shipping documents/delivery tickets so that the Material Receipt can be processed by the applicable USCG Air Station receiving personnel.

7.0 Quality Assurance

The Contractor shall be either a 1) FAA Approved Repair Facility or 2) equivalent European

Aviation Safety Agency (EASA) Approved Repair Facility for the radome listed in the schedule of Supplies/Services. The Contractor shall maintain these approvals for the durations of the contract. The Contractor shall provide immediate written notification to the Contracting Officer upon loss of any required approvals.

7.1 Quality Control (QC)

The Contractor is responsible for performing or assuring all inspections, tests, and calibration necessary to substantiate that the goods or services furnished conform to Government’s requirements. The Contractor shall take prompt action to correct conditions that have or could result in goods or services that do not conform to Government requirements. Records of conformance shall be maintained on file at the Contractor’s facility and made available or provided for review by the Government upon request. The Government reserves the right to conduct a site visit of the Contractor’s facility to verify the existence, adequacy and effectiveness of the quality system. Upon request of the Government, the Contractor(s) shall forward a copy of their current certification and QA Manual for review.

7.2 Product Quality Deficiencies Report (PQDR)

Repaired components found to have deficiencies will be returned to the Contractor for investigation under a no-cost Warranty Repair TO and will include a Product Quality Deficiency

Report (PQDR). The Contractor shall report findings of the investigation within thirty (30) calendar days after receipt of the quality deficiency exhibit of the Contracting Officer.

7.3 Inspections

After repairs are complete, each component shall be inspected/checked IAW requirements set forth IAW NAVAIR 01-1A-22 and AFTO 1-1-24 to ensure full compliance with performance standards. For the repair to the radar window area of the radomes assembly.

7.4 Testing

No deviations from testing requirements are authorized. The repaired radomes shall be tested and certified to a Class B rating for transmission efficiency as outlined in the Radio Technical

Commission for Aeronautics (RTCA) DO-213.

7.5 Asset Computerized Maintenance System (ACMS) Procedures

The component to be repaired under this contract are tracked in the USCG’s Asset Computerized

Maintenance System (ACMS). ACMS is the management information system used to schedule and record all USCG equipment maintenance actions and calibration intervals. The radome will be shipped to the Contractor with a Significant Component History Report (SCHR) and

Component Repair Record (CRR) for each component.

7.6 Place of Performance

Work shall be performed at the contractor’s facility. The contractor shall provide all necessary parts, materials, labor, tooling, test equipment and facilities to test, and repair the components listed in the contract.

8.0 Contractor Verification of Components

Upon receipt of components, the Contractor shall notify the Contracting Officer in writing and provide the following information: 1) date the component(s) received at the Contractor’s facility and, 2) confirmation of P/N and S/N on the equipment received and advise the USCG if any if this information does not exactly match the TO. The Contractor shall NOT start work on equipment received that have P/Ns or S/Ns difference that what is shown on the TO unless a TO

Modification is issued correcting the discrepancy. The Government reserves the right to have

“discrepant equipment” returned “As Is”. The Contractor’s failure to confirm receipt of the equipment may result in the Government’s assumption that the components were received at the

Contractor’s facility within seven (7) calendar days of the date on the TO and the P/N and the

S/N information on the equipment matches exactly to the information on the TO for the equipment.

9.0 Applicable Documents

9.1 Government Documents

9.1.1 Federal Aviation Administration (FAA) Advisory Circular AC 43-4A

Federal Aviation Administration (FAA) Advisory Circular AC 43-4A, dated 25 July 1991, Corrosion Control for Aircraft. A copy of this circular is available at www.faa.gov.

9.1.2 FAA Advisory Circular 43-205

FAA Advisory Circular 43-205, dated 25 September 1998, Guidance for Selecting Chemical

Agents and Processes for De-painting and General Cleaning of Aircraft and Aviation Products.

A copy of the circular is available at www.faa.gov.

9.3 Technical Specifications

United States (US) Navy, Naval Air Systems Command (NAVAIR) Technical manual 01-1A-22 and Air Force Technical Manual (AFTO) 1-1-24.

10.1 Monthly Report

The Contractor shall submit a Monthly Report (to the contract specialist at time of award) that includes equipment received for repair for the current month, equipment received for repair during previous months and is still in process, and equipment shipped/delivered during the reports period. The Monthly Report shall be submitted within ten (10) calendar days of the end of the month and shall include the Contract Number, TO Number(s), CLINs, Item Name, P/N, NSN, S/N, date equipment was received at the Contractor’s facility and estimated delivery date and/or updated status. Electronic submissions compatible with Microsoft Office is acceptable.

A Sample Monthly Report format is provided as Attachment 1.

http://www.faa.gov/ http://www.faa.gov/

10.2 Significant Component History Report (SCHR)

The SCHR records the maintenance history of the S/N tracked components. It remains with its corresponding part until reinstalled on an aircraft or is annotated “BER” and scrapped. (NOTE:

Written approval from the Contracting Office is required prior to scrapping a S/N tracked component). The SCHR for scrapped components shall be returned with the component. The

Contractor shall retain a copy of the SCHR for 90 calendar days.

10.3 Component Repair Record (CRR)

The Contractor shall provide a CRR with repaired components. The original CRR, which includes pre-printed nomenclature, Component End Item Number, S/N, P/N, and current

“appropriate maintenance procedures” will be supplied with the part and must be returned with the part. The CRR records the maintenance performed on a S/N tracked component and enrolls or dis-enrolled components from ACMS when those components are scrapped, added to, or removed from the USCG inventory.

At a minimum, the CRR shall identify the equipment and contain a description of the maintenance action performed, parts replaced, Service Bulletins and modifications. The

Contractor shall mail one (1) copy of the CRR to USCG ALC, ATTN: AVENG/ACMS, Elizabeth City, NC 27909-5001 no later than five (5) business days following completion of the rework effort. The original CRR shall be packed with the component. The Contractor shall retain of copy of each CRR for 90 calendar days.

10.4 Certification for Repaired Equipment

All parts repaired under the provisions of this contract must be airworthy and suitable for installation on USCG aircraft. Each returned component shall be tagged with a DD Form 1574

Serviceable Condition Code Tag and a FAA Form 8130-3 or EASA Airworthiness Approval Tag

Form 1, completed in its entirety. The Contractor shall furnish a Certificate of Airworthiness

IAW FAA Procedures and a Certificate of Conformance (COC) IAW FAR 52.246-15 for all components.

11.0 Shipping Instructions

Delivery terms are F.O.B. Destination from Contractor facility to USCG ALC, Elizabeth City, NC under routine conditions. See section 6.3 for AOG shipping instructions.

11.1 Contractor Shipments

Unless otherwise specified on individual task orders issued hereunder, deliverable items shall be shipped to the following address:

USCG ALC

Receiving Section, Building 63

Elizabeth City, NC 27909-5001

Contract Number: (to be determined at time of award)

Task Order Number: (to be assigned at time of issuance)

11.2 Packaging and Preservation

All components and parts covered under this contract shall be stored and shipped in Contractor-provided shipping containers. Any damage sustained during shipment/handling/storage of the components due to Contractor's improper maintenance/packaging and preservation of the container, shall be the responsibility of the Contractor. Any exposed components shall be additionally wrapped for preservation.

11.2.1 Articles shall be packed and shipped per MIL-STD-2073-1 or American Society for

Testing and Materials equivalent, in a manner that will accommodate shipping environments normally encountered within the commercial distribution system and ensure safe transportation at the lowest rate to the point of delivery. Each line replaceable unit shall have its own shipping container. Packaging material shall not consist of popcorn, shredded paper, Styrofoam or any type, or peanut packaging.

11.3 Marking Instructions

All shipping containers/packages shall be marked for delivery IAW the contract or task order.

All parts and assemblies, which require special care during packing, handling or shipping shall be identified and marked appropriately. A copy of the packing slip shall be affixed to the exterior of the package or shipping container and shall contain the following information:

Nomenclature

NSN

Contract Number

Task order/Item Number

S/N

Contractors P/N

Contractor’s Name and Address

Assembly date for new components

11.3.1 All items returned as BER IAW section 3.3 shall also be clearly marked “BER”.

12.0 DELIVERY REQUIREMENTS

13.1 Required Delivery Schedule

The required Delivery Schedule is as follows:

CLIN 0001 and respective option CLINs: no later than sixty (60) calendar days after receipt of task order and components.

CLIN 0002 and respective option CLINs: no later than fifteen (15) calendar days after receipt of the task order and components.

CLINs 0003-004 and respective option CLINs: Quotes as needed.

Note: Early deliveries are accepted and encouraged at no additional cost to the

Government.

14.0 CONTRACT ADMINISTRATION

14.1 Administration Information

This contract will be administered by USCG, ALC, SRR Contracting Branch, Elizabeth City, NC.

14.2 Ordering Office

The following activity is the only unit authorized to place task orders under this contract:

Contracting Officer

USCG ALC, SRR

Elizabeth City, NC 27909-5001

14.3 Contract changes

All requests for contract changes must be submitted in writing to the Contracting Officer.

Changes to the contract may be made only by written agreement of the parties via the form of a contract modification signed by the Contracting Officer.

15.0 CONTRACTOR’S ADDRESS OF CORRESPONDENCE

All correspondence, except as otherwise specified, for the Contractor shall be directed to the following address:

TO BE DETERMINED AT CONTRACT AWARD.

16.0 INVOICE SUBMISSION

Invoices shall be submitted IAW FAR 52.212-4 to either ALC-Fiscal@uscg.mil or mailed to the designated billing office for payment as noted below. The Contractor is HIGHLY encouraged to submit invoices electronically to ALC-Fiscal@uscg.mil.

Chief, Fiscal Branch

USCG ALC

Fiscal Branch, Building 63

1664 Weeksville Road

Elizabeth City, NC 27909

Contract no. (To be assigned at time of award)

Task Order no. (To be assigned at time of issuance) mailto:ALC-Fiscal@uscg.mil mailto:ALC-Fiscal@uscg.mil

16.1 All payments will be made electronically IAW FAR 52.232-33. The Contractor may submit invoice five (5) business days after shipment of items. The invoice will not be approved until all items have been receipted.

Attachment 1

Sample Month Report

Radome Repair Services

Contract Number: ___________________

Report Period Ending: _______________ (insert Month and Year)

Equipment received for Repair this Month

Task Order Number: ____________________

Line

Item No

Item

Name

P/N NSN S/N Date

Received:

Estimated

Delivery:

Status/Repair

Comments:

Task Order Number: ____________________

Line

Item No

Item

Name

P/N NSN S/N Date

Received:

Estimated

Delivery:

Status/Repair

Comments:

Equipment Shipped this Month:

Task

Order

No.

Line

Item

No.

Item

Name

P/N NSN S/M Date

Received

Date

Shipped

Turn-

Around-

Time

CERTIFICATE OF CONFORMANCE IN ACCORDANCE WITH

FAR 52.246-15

“I certify that on _______ (Date), the ___________________________ (Contractor’s Name) furnished supplies or services call for by Contract Number ___________via____________

(Carrier) ________________________________ (Bill of Landing/Shipping Document) in accordance with all applicable requirements.

I further certify that the supplies or services are of the quality specified and conform in all respects with the contracts requirements, including specifications, drawings, preservation, packaging, marking requirements, and physical item identification (Part Number), are in the quantity shown on this or on the attached acceptance document.”

Date of Execution: __________________________

Signature: _________________________________

Title: _____________________________________