813.pdf
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- Attached to
- LINER, COMBUSTION CH
- Solicitation number
- FA812126R0016
About this file
This is an Air Force Materiel Command (AFMC) Surplus Materiel Worksheet evaluating the potential use of surplus government inventory to fulfill a requirement for part number 4084071-01 (NSN 2840014491573NZ), manufactured by CAGE 77445 for the F100 application.
The evaluation, completed on January 12, 2022, determined that surplus materiel may be considered for this item and established specific acceptance criteria. The acceptable surplus categories identified include new/unused government surplus items only. Evaluation criteria require part number and manufacturer verification (MFG 77445, P/N 4084071-01), prior government ownership confirmation, 100% end item inspection, test and verification, and verifiable dimensions based on design activity 77445 and drawing number 4084071-01. The surplus parts must be in original unopened packaging, correctly labeled with part number, NSN, and original government contract number. Rejection criteria include misrepresentation by the vendor, inability to trace parts to a U.S. Government contract number, packaging damage, or any evidence of corrosion. The worksheet was completed by Eric C. Shelley (AFLCMC/LPSEA1) and initiated by Craig A. Ashcroft (421 SCMS/GUMAD), with rejected parts to be returned to the vendor at no government cost.
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| Item Description.pdf | ||
| CDRL1_REPORT.pdf | ||
| First Article Requirements.pdf | ||
| MQR.pdf | ||
| 807.pdf | ||
| IUID.pdf | ||
| EDL.pdf | ||
| First Article DID.pdf | ||
| First Article Test Plan.pdf | ||
| FA812126R0016_Solicitation.pdf | ||
| 4248680_EI.docx | DOCX document | |
| DID.pdf | ||
| Packaging.pdf | ||
| Transportation.pdf |
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Text version
SURPLUS MATERIEL WORKSHEET
DATE
10 JAN 2022
I. REQUEST FOR EVALUATION
NSN
2840014491573NZ
PART NUMBER
4084071-01
CAGE
77445
APPLICATION
F100
IMS
Ashcroft, Craig A
OFFICE SYMBOL
421 SCMS / GUMAD
PHONE
405-734-5381
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 4084071-01P/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
VERIFIABLE DIMENSION (AFMCFARS 5352.211-9012) DESIGN ACTIVITY 77445
DRAWING NUMBER 4084071-01
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)
Parts will be in original unopened package, labeled with the correct part number, NSN and original government contract number.
OTHER SPECIAL REQUIREMENTS (Explain)
REMARKS
JUSTIFICATION FOR UNACCEPTABLE SURPLUS MATERIEL
Required Information for Surplus Material Evaluation in accordance with FAR 11.302(b)
- Misrepresentation of an item by the surplus vendor shall be cause for rejection.
- Parts that cannot be traced to a US Government contract number 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 the entire lot.
- Rejected parts will be returned to the vendor at no cost to the government.
EVALUATOR
Shelley, Eric C
OFFICE SYMBOL
AFLCMC / LPSEA1
PHONE
405-734-0001 / 884-0001
COMPLETE DATE
12 JAN 2022
SIGNATURE
//SIGNED// Shelley, Eric C
USER TYPE
Engineer
SIGNATURE DATE
12 JAN 2022
Page 1 of 1AFMC FORM 813, 20000323 (IMT-V1) Version 12Generated by PRPS using Jasper Reports on 23 Apr 2026
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