Attachment 0001 Traceablility Document.pdf

PART I - TO BE COMPLETED BY THE SUPPLIER

TRACEABILITY/TEST DOCUMENTATION COVER SHEET

3. SUBMITTED

BY

1. TYPE OF DOCUMENTATION ATTACHED/SUBMITTED

Traceability Documentation

Test Report

a. Name

c. Phone No.

2. DATE

b. E-mail

4. SUPPLIER a. Company b. CAGE

c. Address

5. ITEM a. Contract No. b. CLIN

d. Item Name/Description

e. FSC f. NIIN g. Part No.

c. Qty

h. Part Manufacturer i. Mfr CAGE

6. AWARD INFORMATION -- TRACEABILITY/TEST DOCUMENTATION REQUIREMENTS IN ACCORDANCE WITH DFARS 252.246-7008 & DLAD PROCUREMENT NOTE M01 APPROVED SUPPLIERS for FSC 5961 Semiconductors and FSC 5962 Electronic Microcircuits The Supplier listed in block 4 of this form offered, and was awarded the contract listed in block 5a of this form as a: (Check Box That Applies)

Approved Source Manufacturer Specified in the Solicitation/Contract Item Description (Original Component Manufacturer (OCM), Original Equipment Manufacturer (OEM)) Required Documentation of Traceability: Completed DLA L&M Form 918. If the bare item markings on the parts being provided do not match the CAGE and part number specified in the item description in the contract, the supplier must provide documentation certifying that the parts containing the alternate markings are the "exact product" as the item represented by the CAGE and part number specified in the in the contract item description.

Authorized Distributor of the OCM/OEM or QPL/QML Approved Source Required Documentation of Traceability: Evidence of a contractual arrangement with or the express written authority of the manufacturer or current design activity to buy, stock, sell or distribute the part and an unbroken chain of traceability documentation through authorized distributors (if applicable), back to the approved source/manufacturer specified in the solicitation/contract.

Supplier/Distributor on the Qualified Supplier List of Distributors (QSLD) for FSC 5961/5962 Required Documentation of Traceability: Evidence of unbroken chain of traceability documentation, through trusted providers, back to an approved manufacturer specified in the solicitation/contract item description. Refer to the QSLD-5961/5962 document.

QPL/QML items require a Certificate of Conformance and Traceability (CoC/T), which must include information and documentation required by the applicable military specification for the QPL/QML product. Refer to DLA Technical and Quality Requirement RQ007.

Supplier/Distributor on the Qualified Testing Suppliers List (QTSL) for FSC 5961/5962 Required Documentation of Testing: Complete test report including summary of test results, electrical testing read and record data, device photos, etc. Traceability documentation to the source of parts provided for testing. Refer to DLAD Procurement Note M01.

PART II - TO BE COMPLETED BY DLA

REVIEWER Name Date

j. Date Code(s)

Approved Source on the Applicable Qualified Products List (QPL)/Qualified Manufacturers List (QML) Required Documentation of Traceability: Completed DLA L&M Form 918. Also requires a Certificate of Conformance and Traceability (CoC/T), which must include information and documentation required by the applicable military specification for the QPL/QML product.

Refer to DLA Technical and Quality Requirement RQ007.

DLA LAND AND MARITIME FORM 918 (AUG 2017) Page 1 of 2 PDF(DLA L&M)

DLA LAND AND MARITIME FORM 918 (AUG 2017) Page 2 of 2 PDF(DLA L&M)

TRACEABILITY/TEST DOCUMENTATION COVER SHEET

INSTRUCTIONS

NOTE: The Contracting Officer reserves the right to, at any time, request additional documentation of traceability or test report. The Contractor must maintain and be prepared to provide traceability/test documentation in accordance with the clauses within the awarded contract listed in Block 5a of this form.

Block 6 - AWARD INFORMATION -- TRACEABILITY / TEST

DOCUMENTATION REQUIREMENTS

Indicate the category of trusted supplier for which the supplier listed in Block 4 of this form has offered, and was awarded the contract listed in Block 5a of this form. The categories of trusted suppliers are--

Approved Manufacturer Specified in the Solicitation/ Contract Item Description -- The source identified by name, CAGE, and part number listed in the purchase item description in Section B of the award. This category of supplier shall only be selected if the entity in Block 4 of the form is--

1) the original manufacturer of the part

2) the original component manufacturer

3) the original equipment manufacturer

4) manufacturer specified in the solicitation/contract item description

5) the part Design Control Activity, which is defined as the entity having responsibility for the design of a given part and for the preparation and currency of engineering drawings and other technical data (TD) for that part.

Authorized Distributor of the Approved Manufacturer Specified in the Solicitation/Contract Item Description -- A supplier who has a contractual arrangement or the express written authority with 1-5 above to buy, stock, re-package, sell, and distribute the item specified in the solicitation/contract.

Supplier/Distributor on the Qualified Supplier List of Distributors (QSLD) for FSC 5961/5962 -- A distributor listed or determined qualified for listing on the DLA Land and Maritime Qualified Supplier List of Distributors (QSLD) for FSC 5961/5962.

Supplier/Distributor on the Qualified Testing Suppliers List (QTSL) for FSC 5961/5962 -- A distributor listed or determined qualified for listing on the DLA Land and Maritime Qualified Testing Suppliers List (QTSL) for FSC 5961 and 5962.

Part II

The DLA Land and Maritime contract administrator conducting the documentation review will enter his/her name and date to acknowledge the receipt of the form and accompanying traceability/test report. The entry of the reviewer's name and date does not signify a determination by the Government that the DLA L&M Form 918 and accompanying traceability documentation/test report is acceptable. Notification of acceptance will be provided by Contracting Officer letter.

Part I

Block 1 - TYPE OF DOCUMENTATION ATTACHED/SUBMITTED:

Indicate the type of documentation being submitted. "Test Report" refers to a complete test report in accordance with the SAE AS6081 guidelines required by the Criteria and Provisions for Qualified Testing Suppliers List (QTSL-5961/5961).

Block 2 - DATE: Enter the date the Supplier filled out the form.

Block 3 - SUBMITTED BY: Enter the name, E-mail address, and phone number of the person submitting the form. The person listed in Block 3a must be an individual who has the authority to bind the Contractor.

Block 4 - SUPPLIER: Enter the company name, Commercial and Government Entity (CAGE) code, and address of the entity to which the contract/purchase order was awarded.

Block 5 - ITEM

a. Contract No.: Enter the Contract/Purchase Order/Agreement Number and, if applicable, the Delivery Order/Call Number of the order for which the item(s) are being provided.

b. CLIN: Enter the Contract Line Item Number (CLIN) representing the item(s) being provided.

c. QTY: Enter the quantity of item(s) being provided.

d. Item Name/Description: Enter the Item Description (item name) as it appears in the contract.

e. FSC: Enter the Federal Supply Class (FSC) code. The FSC is the first four digits of the 13-digit National Stock Number (NSN).

f. NIIN: Enter the National Item Identification Number (NIIN). The NIIN is the last nine digits of the 13-digit NSN.

g. Part No., h. Part Manufacturer, i. Mfr CAGE: Enter the manufacturer's part number, the part manufacturer, and the manufacturer's CAGE code for the item(s) being provided. The part manufacturer, CAGE, and part number entered shall be the same as what is in the product item description in the contract.

j. Date Code(s): Enter the manufacturing date codes for the parts being provided. The standard date code is four (4) numbers representing the year and week in that year the part was manufactured. Note: Some date codes will contain prefix and/or suffix pertaining to certain manufacturers.