Attachment_3_Data_Requirements.pdf

CONTRACT __________________

PRINTED 6 MAY 2021 PAGE _______

EXHIBIT A

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

CONTRACT DATA REQUIREMENTS LIST

SYSTEM/ITEM: DEMINERALIZER CATEGORY ____________

ITEM NO CONTRACTOR

01 SEQ NO A001

02 DATA DESC CERTIFICATION OF HYDROSTATIC TEST

03 SUBTITLE

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.9.1

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 410 __/ 0 VIA MAIL (N0 DD 250 REQD)

15 TOTAL __

16 REMARKS

SEQ. NO. A001

PREPARED BY ________________________________________________ DATE__________________ APPROVED BY ________________________________________________ DATE__________________

DD FORM 1423

PRINTED 6 MAY 2021 PAGE _______

SYSTEM/ITEM: HIC LIFT BASKET CATEGORY ____________

01 SEQ NO A002

02 DATA DESC CERTIFICATE OF COMPLIANCE

03 SUBTITLE SAFETY FACTOR OF 10:1

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.9.2

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 410 __/ 0 VIA MAIL (N0 DD 250 REQD)

SEQ. NO. A002

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01 SEQ NO A003

02 DATA DESC CERTIFICATION OF LOAD TEST

03 SUBTITLE LIFTING POINTS

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.9.3

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 410 __/ 0 VIA MAIL (N0 DD 250 REQD)

SEQ. NO. A003

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01 SEQ NO A004

02 DATA DESC CERTIFICATION OF LOAD TEST

03 SUBTITLE SHACKLES

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.9.4

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 410 __/ 0 VIA MAIL (N0 DD 250 REQD)

SEQ. NO. A004

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01 SEQ NO A005

02 DATA DESC CERTIFICATION OF MAGNETIC PARTICAL TEST

03 SUBTITLE LIFTING POINT

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.9.5

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 410 __/ 0 VIA MAIL (N0 DD 250 REQD)

SEQ. NO. A005

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01 SEQ NO A006

02 DATA DESC CERTIFICATION OF MAGNETIC PARTICAL TESTING

03 SUBTITLE AREA AROUND LIFTING POINT

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.9.6

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 410 __/ 0 VIA MAIL (N0 DD 250 REQD)

SEQ. NO. A006

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SYSTEM/ITEM: HIC LIFTING BASKET CATEGORY ____________

01 SEQ NO A007

02 DATA DESC CERTIFICATION OF MAGNETIC PARTICAL TESTING

03 SUBTITLE EACH SHACKLE

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.9.7

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 410 __/ 0 VIA MAIL (N0 DD 250 REQD)

SEQ. NO. A007

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SYSTEM/ITEM: HIC LIFTING BASKET CATEGORY ____________

01 SEQ NO A008

02 DATA DESC CERTIFICATION OF MATERIAL COMPOSITION

03 SUBTITLE RR-C-271 (GRADE A OR B) IR ASTM A314 (PLEASE SPECIFY)

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.9.8

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 410 __/ 0 VIA MAIL (N0 DD 250 REQD)

SEQ. NO. A008

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ATTACHMENT 1 TO EXHIBIT A (DD FORM 1423)

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.

PRINTED 6 MAY 2021 PAGE _______

ATTACHMENT 1 TO EXHIBIT A (DD FORM 1423)

CERTIFICATE OF COMPLIANCE

COMPANY NAME

MATERIL 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.

SIGNATURE ___________________________________________________ DATE _______________

QUALITY ASSURANCE OFFICIAL