Attachment 3 - Contract Data Requirements.docx

CONTRACT __________________

PRINTED 25 APRIL 2022 PAGE _______

ATTACHMENT 1 TO EXHIBIT A (DD FORM 1423)

REQ DOC NO. - BULK NITROGEN 22-27 ATTACHMENT _________

CONTINUATION SHEET CONTRACT NO. - _______________ PAGE ___ OF ___

NAME OF OFFER OR/CONTRACTOR

______________________________________________________________________________ITEM # SUPPLIES/SERVICES QTY U/I

BULK NITROGEN 1 JO

(PNSY USE ONLY: 6830 00-285-4769

C. DESCRIPTION/SPECIFICATIONS

C.1 PROVIDE 60,000 GALLONS OF LIQUID NITROGEN IN ACCORDANCE WITH COMMERCIAL ITEM DESCRIPTION (CID) A-A-59155 (DATED 5 MARCH 2003), TYPE II, GRADE A OR B.

C.2 SEE STATEMENT OF WORK FOR ADDITIONAL INFORMATION AND REQUIREMENTS.

C.3 DATA REQUIREMENTS PER EXHIBIT A (DD-1423) & ATTCHMENT #1.

C.3.1 SAFETY DATA SHEETS, NITROGEN; EXHIBIT A SEQUENCE A001.

C.3.2 CERTIFICATION OF COMPLIANCE; EXHIBIT A SEQUENCE A002.

(ADP DD FORM 1423 (MECHANIZED EQUIVALENT) PER DAR CLAUSE 16-815)

CONTRACT DATA REQUIREMENTS LIST

SEQ. NO. A001

CONTRACT __________________

PRINTED 25 APRIL 2022 PAGE _______

ATTACHMENT 1 TO EXHIBIT A (DD FORM 1423)

(ADP DD FORM 1423 (MECHANIZED EQUIVALENT) PER DAR CLAUSE 16-815)

CONTRACT DATA REQUIREMENTS LIST

SEQ. NO. A002

CONTRACT/SOLICITATION ________________________________________________________________ ITEM ___________________________________________ (DATE FOR ITEM) ___________________

REQUIRED CERTIFICATION

A. CERTIFICATION SHALL BE SUPPLIED WITH EACH SHIPMENT OF MATERIAL. CERTIFICATION (CERTIFICATE OF COMPLIANCE) SHALL BE SUPPLIED AS OUTLINED IN PARAGRAPH B. THE VENDOR IS LIABLE FOR CONDUCTING ALL TESTS, ANALYSES, INSPECTIONS, AND EXAMINATIONS, ETC., AS SPECIFIED BY THE CONTRACT AND SPECIFICATIONS WHETHER CERTIFICATIONS ARE REQUIRED OR NOT.

CERTIFICATE OF COMPLIANCE (PROVIDE THE FOLLOWING VERBATIM STATEMENT OR COMPLETE THE OPTIONAL FORM AT THE END OF THIS PART)

"I ATTEST ALL ITEMS FURNISHED ON THIS CONTRACT ARE IN FULL COMPLIANCE WITH ALL CONTRACT REQUIREMENTS".

B. CERTIFICATION SHALL BE SUPPLIED PER THE FOLLOWING INSTRUCTIONS:

1. THE CERTIFICATION OF COMPLIANCE SHALL CONTAIN THE SIGNATURE AND TITLE OF THE VENDOR OFFICIAL DESIGNATED RESPONSIBLE FOR QUALITY ASSURANCE.

2. THE MATERIAL IDENTIFICATION (E.G. LOT, BATCH, PART #, ETC.) SHALL BE INCLUDED ON THE CERTIFICATE OF COMPLIANCE.

CERTIFICATE OF COMPLIANCE

COMPANY NAME

MATERIAL IDENTIFICATION (COMPLETE APPLICABLE ITEMS)

CONTRACT NO. ______________ ORDER NO. ________________ ITEM NO. ____________________ NATIONAL/LOCAL STOCK NO. NSN/LSN ____________________________________________________ MANUFACTURER’S PART NO. _____________________________________________________________ MANUFACTURER’S SERIAL NO. ___________________________________________________________ DRAWING AND PIECE NO. _________________________________________________________________

MANUFACTURER’S LOT/HEAT NOS. AS MARKED ON THE MATERIAL _________________________

ALL INSPECTIONS AND TEST REPORTS REQUIRED BY ATTACHMENT I TO EXHIBIT A (DD FORM 1423) FOR TRACEABILITY TO EACH CONTRACT ITEM MUST ACCOMPANY THIS SIGNED STATEMENT:

THE INSPECTION AND TEST REPORTS (AS APPLICABLE) PROVIDED REPRESENT THE ACTUAL ATTRIBUTES OF THE ITEMS FURNISHED ON THIS CONTRACT AND INDICATE FULL COMPLIANCE WITH ALL CONTRACT REQUIREMENTS. I ATTEST ALL ITEMS FURNISHED ON THIS CONTRACT ARE IN FULL COMPLIANCE WITH ALL CONTRACT REQUIREMENTS.