B08 - Attachment 0009 -DRW-11E421711.pdf
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About this file
This document is a Contract Quality Requirements Worksheet for an Oxy High Pressure Hose Assembly (Part Number 11E421711-1) procured from S.J. Smith Co., Inc. The hose is a high-pressure oxygen hose with specific technical specifications: 180 inches nominal length, 1/4 inch hose size, constructed of 304 stainless steel flexible braid with a Teflon core, and rated for 3000 PSIG maximum pressure. The hose features brass right-hand female threads with a check valve on the inlet side and includes gas service and pressure rating labels.
The worksheet indicates government quality assurance requirements, including inspection by an ACO-authorized representative, acceptance at RIA-JMTC, and a Certificate of Conformance requirement. The vendor (S.J. Smith Co., Inc.) is identified with CAGE Code 2N560, and the item is associated with the US Army Combat Capabilities Development Command Armaments Center. The document specifies that the hose must maintain not less than 85% shelf life remaining upon receipt, in accordance with DOD 4140.27M standards.
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Text version
Contract Quality Requirements Worksheet Requisition/WBS Number
QA Specialist Date
Qualified Products/Producers List
X Government Actions will be performed by ACO authorized Representative at Source FAR 46.202, 46.405 X RIA JMTC FAR 46.403, 46.404
X Acceptance at Source X RIA JMTC
Government Reliance on Inspection by Contractor FAR 52.246 1
X Inspection by the Government FAR 52.246 2
Higher Level Contract Quality Requirements FAR 52.246 11 ANSI/ISO/ASQ Q9001 2015 Other
Applicable Documents Below Attached
X Certificate of Conformance FAR 52.246 15
Certified Test Report (CTR)
Government Designed Acceptance Inspection and Test Equipment (Attached)
First Article Approval, Government Testing (Attached) FAR 52.209 4
First Article Approval, Contractor Testing (Attached) FAR 52.209 3
First Article Parts Required? No Yes Quantity
First Article Parts will be:
Accepted as Part of the Production Run Returned to Vendor
Preproduction Material Approval Government Testing (Attached)
Ballistic Testing (Attached)
Shelf Life: FAR 46.706 DOD 4140.27M (not less than 85% shelf life remaining upon receipt)
X Other:
RIA FORM 702 2, JUL 2010 Previous Editions may not be used
RIA PE v2.00
OXY HIGH PRESSURE HOSE ASSY
PURCHASE PER DRAWING 11E421711 FROM S.J. SMITH CO,. INC. , CAGE CODE 2N560, VENDOR PART NO. PF63CV180B1, VENDOR DESCRIPTION HOSE, FITTING ASSY, HIGH PRESSURE, OXTGEN, TYPE HIGH PRESSURE HOSE, LENGTH 180 INCHES NOMINAL, HOSE SIZE 1/4 INCH, GAS TYPE OXYGEN, HOSE TYPE 304 STAINLESS STEEL FLEXIBLE BRAID WITH TEFLON CORE, CONNECTIONS BRASS RH FEMALE THREAD WITH CHECK VALVE IN INLET SIDE; CGA 540, HOSE PRESSURE RATING 3000 PSIG MAX, SPECIAL FEATURES INCLUDES GAS SERVICE AND
PRESSURE RATING LABELS
D. Rozkalns (309) 782 5565
22_230109085355
EH21MRI928EHM5
JO_PCN End Item
FRS
Part Number
11E421711 1RIA:59678 N/A
NSN/NIIN
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