Attachment 11 - F76 Traceability Signature Page.pdf
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- Attached to
- Rocky Mountain/West Coast Program
- Solicitation number
- SPE60226R0702
- Issued by
-
Defense Logistics Agency Energy
About this file
These are certification forms issued by the Defense Logistics Agency Energy for F-76 military jet fuel contracts. The forms require suppliers to certify compliance with MIL-DTL-16884 specifications and document the composition and traceability of fuel supplied under government contracts.
The F-76 Traceability Signature Page requires contractors to certify that fuel maintains traceability regarding materials composition, additives, and their concentration levels, with assurance that no unauthorized un-hydrotreated light cycle oils, unauthorized materials, or additives have been blended into the final product. Contractors must select one of three traceability options and list all materials (including refined hydrocarbon distillate fuel, Fischer-Tropsch, and Hydroprocessed Renewable Diesel) with their percentages, as well as all additives with their concentration levels and the responsible party for injection. The form must be signed by an authorized representative with printed name, title, company name, and date. The F-76 Synthetic Component Certification form certifies that synthetic paraffinic materials are derived from either Fischer-Tropsch or Hydroprocessed Renewable Diesel methods and that no changes have been made to feedstock material, production location, production processes, or equipment since the most recent certificate of analysis. The certification requires the date and identifying number of the most recent certificate of analysis and must be signed by an authorized company representative with printed name, title, company name, and date.
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Text version
DEFENSE LOGISTICS AGENCY ENERGY
8725 JOHN J. KINGMAN ROAD
FORT BELVOIR, VIRGINIA 22060-6222
DISTRIBUTION STATEMENT – A: APPROVED FOR PUBLIC RELEASE. DISTRIBUTION IS UNLIMITED
F-76 Traceability Signature Page
Contract or Solicitation Number:
CLIN:
Order Number:
Shipment Number:
Traceability OPTION selected per paragraph e.5 (circle or otherwise indicate which one of the three options is chosen):
OPTION 1 OPTION 2 OPTION 3
F-76 fuel supplied under the above contract, CLIN, order number and shipment number maintains traceability with respect the materials composition, additives and their concentration levels. This signed statement certifies that at no point have any unauthorized un- hydrotreated light cycle oils, other unauthorized materials, or additives been blended into the final product or any of its associated blend components per the most recent revision of MIL-DTL-16884 at date of contract award. All materials and additives are listed below. The percentage of each material as defined in sections 3.2, 3.2.2, and 3.2.3 (i.e. refined hydrocarbon distillate fuel, Fischer-Tropsch, Hydroprocessed Renewable Diesel, etc.) and the concentration level for each additive are also shown. For the purposes of the offeror submission this signed statement attests that no unapproved additives or materials will be added to batches or components of batches of F- 76 for delivery under government contracts.
Signature:
Printed Name:
Title:
Company Name:
Date:
Material Percent
Additive Concentration Responsible Party for Injection
DEFENSE LOGISTICS AGENCY ENERGY
8725 JOHN J. KINGMAN ROAD
FORT BELVOIR, VIRGINIA 22060-6222
DISTRIBUTION STATEMENT – A: APPROVED FOR PUBLIC RELEASE. DISTRIBUTION IS UNLIMITED
F-76 Synthetic Component Certification
Contract or Solicitation Number:
CLIN:
Order Number:
Shipment Number:
Synthetic paraffinic materials supplied as indicated with the above contract, CLIN, order number, and shipment number is derived from either Fischer-Tropsch (FT) or Hydroprocessed Renewable Diesel (HRD) methods. This signed statement certifies that since the last certificate of analysis (COA), including table A-II or B-II results of MIL-DTL-16884P, Appendix A or B, no changes, including feedstock material, production location, or production processes have been made. In addition, no turnaround events have been executed on any units utilized to produce the synthetic paraffinic materials since the last COA, including table A-II or B-II, properties were tested. Please supply the date of the most recent COA and an identifying number for that report in the space provided below.
DATE OF COA: _
LAB REPORT ID NUMBER
Signature:
Printed Name:
Title:
Company Name:
Date:
File details come from the government source that posted it. Updated .