SMW_REPORT.pdf

SURPLUS MATERIEL WORKSHEET

DATE

05 APR 2012

I. REQUEST FOR EVALUATION

NSN

5680013915100FW

PART NUMBER

MS-266 TY1 3.0TX960WX36.5L

CAGE

1W025

APPLICATION

B002A

IMS

JACK, DAVID B

OFFICE SYMBOL

424 SCMS / GUME

PHONE

405-739-7161

SURPLUS MATERIEL MAY BE AVAILABLE TO FULFILL THE GOVERNMENT'S NEEDS FOR THIS ITEM. AS A RESULT, AN EVALUATION MUST BE PERFORMED

IAW AFMC FAR SUPPLEMENT PART 5352.

THE EVALUATION ON THIS ITEM INDICATES SURPLUS MATERIEL WILL BE CONSIDERED IN THE FOLLOWING TYPES / CATEGORIES

II. EVALUATION CRITERIA (For types/categories deemed acceptable)

ACCEPT-

ABLE (Y/N)

P/N AND

MFG

VERIFI-

CATION

PRIOR

GOV'T

OWNER-

SHIP

100% END

ITEM

INSPECT

TEST AND

VERIFI-

CATION

VERIFI-

ABLE

DIMEN-

SIONS

LOCATION

INSPEC-

TION

TESTING

INITIAL

ACCEPT-

ABILITY

ITEMS

OVERHAUL

AND

CERTIFI-

CATION

OTHER

(Explain in Remarks)

N

N

N

N

N

N

N

N

G O V T

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

C O M M L

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

SURPLUS EVALUATION CRITERIA (If Section 11a. indicates surplus materiel may be considered). (Fill in blanks as appropriate)

PART NUMBER VERIFICATION 1W025(AFMCFARS 5352.211-9011) MFG MS-266 TY1 3.0TX960WX36.5LP/N

PRIOR GOVERNMENT OWNERSHIP (AFMCFARS 5352.211-9015)

100% END ITEM INSPECTION (AFMCFARS 5352.211-9017)

TEST AND VERIFICATION (AFMCFARS 5352.211-9013) TECH ORDER NUMBER

VERIFIABLE DIMENSION (AFMCFARS 5352.211-9012) DESIGN ACTIVITY

DRAWING NUMBER

LOCATION OF INSPECTION TESTING (AFMCFARS 5352.211-9015)

INITIAL ACCEPTABILITY ITEMS (AFMCFARS 5352.211-9014) A QUANTITY OF ITEMS WILL BE TESTED FOR INITIAL ACCEPTANCE

TEST WILL BE CONDUCTED USING THE FOLLOWING CRITERIA (and location of testing)

OVERHAUL AND CERTIFICATION (AFMCFARS 5352.211-9010)

OTHER SPECIAL REQUIREMENTS (Explain)

PELTIER, HALLIE RNAME: 18 APR 2012DATE:

Surplus offers will be evaluated on a case-by-case basis.

REMARKS

JUSTIFICATION FOR UNACCEPTABLE SURPLUS MATERIEL

Reference Pat Richardson Policy Letter dated 19 December 2008. Provide electronic copy of quote with name and CAGE Code of vendor, part number, NSN, original Government contract number and proof of prior Government ownership. Unopened packaging required with digital image of original part label with original Government contract number and Safety of Flight determination letter, to be signed only by the cognizant lead engineer of the weapon system end-item.

EVALUATOR

Diehl, Roderick E

OFFICE SYMBOL

424 SCMS / GUEA

PHONE

405-736-5515 / 336-5515

COMPLETE DATE

20 APR 2012

SIGNATURE

//SIGNED// Diehl, Roderick E

USER TYPE

Engineer Workload Manager

SIGNATURE DATE

20 APR 2012

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