AFMC Form 762- SAW.pdf

CONTRACT REPAIR SCREENING ANALYSIS WORKSHEET

PART I (To be completed by PMS Seller)

1. FORM INITIATION DATE

21 NOV 2019

2. FORM PRIORITY

3. NSN

4920011392801MH

4. PART NUMBER

811-00148

5. PART NUMBER CAGE CODE

52497

6. NOUN

TEST SET,ENVIRONMEN

7. ANNUAL REPAIR

QUANTITY

8. LATEST REPAIR COST

$10,938.0000

9. ANNUAL REPAIR

BUDGET VALUE

$109,380.00

10. FORECAST UNIT

PRICE

$12,228.1600

11. ERRC

S

12. WEAPON SYSTEM

ACES II Ejection System

13. END ITEM APPLICATION

TTU-415E

14. HISTORY

DOES ORGANIC REPAIR OR DMISA REPAIR CAPABILITY CURRENTLY EXIST? X NO YES (if yes, specify SOR)

HAS THE ITEM PREVIOUSLY BEEN CONTRACT REPAIRED?

IF YES, COMPLETE TABLE BELOW FOR LAST 5 YEARS (not to exceed last 3 contracts)

NO X YES

SOURCE NAME CAGE CONTRACT NUMBER AWARD DATE

FXC CORPORATION 29 AUG 201952497 FA853419F0069

FXC CORPORATION 30 AUG 201852497 FA853418F0087

FXC CORPORATION 28 JUL 201752497 FA853417F0073

FXC CORPORATION 12 AUG 201652497 FA853316F0017

FXC CORPORATION 24 SEP 201552497 FA851915D00030001

15. PMS SELLER NAME

Vrahiotes, Amanda L

CODE

WSG

OFFICE SYMBOL

404 SCMS / GUMAAC

PHONE

478-926-0899

COMPLETION DATE

21 NOV 2019

PART II (To be completed by Equipment Specialist)

16. TECHNICAL ORDERS REQUIRED NO X YES (annotate required data and availability on RDL) UNKNOWN

17. OTHER SPECIFICATIONS / SPECIAL REPAIR CRITERIA REQUIRED NO YES (annotate required data and availability on RDL) X UNKNOWN

18. X THE DATA LISTED IN RDL COMPLETED SPECIFIES THE REPAIR REQUIREMENTS OR

ADDITIONAL DATA IS REQUIRED (Coordinate with the engineer and screening office to determine information required. Document in Block 33)

19. SPECIAL TOOL / SPECIAL TEST EQUIPMENT IS X NOT REQUIRED REQUIRED REQUIRED BUT NOT AVAILABLE

SPECIAL FACILITIES ARE X NOT REQUIRED REQUIRED

GOVERNMENT FURNISHED MATERIAL IS X NOT REQUIRED REQUIRED REQUIRED BUT NOT AVAILABLE

20. EQUIPMENT SPECIALIST NAME

Williams, Richard A

CODE

TH

OFFICE SYMBOL

AFLCMC / WNUS

PHONE

478-222-7437

COMPLETION DATE

21 NOV 2019

PART III (To be completed by Screening Technician if applicable)

21. REQUESTED ENGINEERING DATA

LISTED AND ANNOTATED ON RDL X NO DATA

22. SCREENING TECHNICIAN REMARKS

23. SCREENING TECHNICIAN NAME CODE OFFICE SYMBOL PHONE COMPLETION DATE

PART IV (To be completed by the Engineer)

24. CRITICAL SAFETY ITEM

X NO YES

25. CAN THIS ITEM BE COMMERCIALLY

OVERHAULED / REPAIRED (FAR Part 12)

X NO YES

26. PRECONTRACT QUALIFICATION

REQUIRED

X NO YES (JQR/QR, SQS, Waiver)

27. RDL REQUIRED FOR

SOLICITATION

X NO YES

28. RMC / RMSC CODE

R3 / R

29. RMC / RMSC EXPIRATION DATE

22 JAN 2025

30. REASON FOR OTHER THAN G CODE AND ACTION TO REMEDY

Tester is sole source and is proprietary to FXC (OEM).

31. APPROVED / POTENTIAL SOURCES

CAGE

CODE DATE APPROVED

FXC CORPORATION 52497

Page 1 of 2AFMC FORM 762, 20060201, V1 Version 10Generated by PRPS using Jasper Reports on 22 Jan 2020

CONTRACT REPAIR SCREENING ANALYSIS WORKSHEET

32. ENGINEER NAME

Long, Dallas N

CODE

N/A

OFFICE SYMBOL

AFLCMC / WNUS

PHONE

478-222-7418

COMPLETION DATE

22 JAN 2020

PART V (Miscellaneous, if needed)

33. REMARKS (Remarks require Functional Responsibility / Name / Office Symbol / Phone)

USER TYPE: Engineer NAME: McDuffie, Jason G DATE: 14 JUL 2014

ORG / OFFICE SYMBOL: WR-ALC / GRVEC COMMERCIAL PHONE: 478-222-1741 DSN PHONE: 472-1741

Please note that the 762 indicates that this item is not CSI; the selection of "N" is inherent to the 762 form and cannot be changed by AFLCMC/WNUS. The item is in process of being added to the AF CSI list. NOTE: The coding of CSI is relatively new to DoD as it was not formally introduced until around 2006.

USER TYPE: Equipment Specialist NAME: Williams, Richard A DATE: 10 JUL 2014

ORG / OFFICE SYMBOL: AFLCMC / WNZED COMMERCIAL PHONE: 478-222-7439 DSN PHONE: 472-7439

T.O 33D2-39-26-1

USER TYPE: Equipment Specialist NAME: Williams, Richard A DATE: 13 JUN 2011

ORG / OFFICE SYMBOL: WR-ALC / GRVCAA COMMERCIAL PHONE: 478-222-7437 DSN PHONE: 472-7437

Item has been repaired by FXC Corp.

USER TYPE: Production Management Specialist - Seller NAME: Brooks, Angela D DATE: 07 AUG 2009

ORG / OFFICE SYMBOL: 579 CBSS / GBLD COMMERCIAL PHONE: 478-222-1818 DSN PHONE: 472-1818

Will you complete Section II and pass to the engineer to complete Section III please? The engineer must complete the approved source block.

Page 2 of 2AFMC FORM 762, 20060201, V1 Version 10Generated by PRPS using Jasper Reports on 22 Jan 2020