CDRL_PROOF_LOAD_CERTS_A001.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved (1 Data Item) OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding thus burden estimate or any other aspect of this collection o f information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract|PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP X TM OTHER

D. SYSTEM ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1730-01-087-7148

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE

GROUP

A001 Test/Inspection Report Proof Load Certificates

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

DI-NDTI-80809B DWG 160D497840-3 AFLCMC/WNZEA

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

SS See block 16 See block 16 b. COPIES

8. APP CODE C 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRAFT FINAL

N/A See block 16 See block 16 Reg Repr o

16. REMARKS

Reference DWG 160D497840-3 for proof load diagram See block 16

Blocks 10-13:

Each item shall be proof load tested in accordance with applicable drawings and specifications. Contractor shall coordinate testing of first item with DCMA. A government QAR shall witness and sign off testing the first item. A Proof Load Certificate shall be written per proof load test performed. This certificate will serve as proof the item was proof tested and has passed proof testing by the manufacturer. Contractor format for certificate is acceptable. A copy of the original Proof Load Certificate shall be shipped with each item. A digital soft copy of the original Proof Load Certificate shall be provided to the addressee in block 14 for only the first item tested.

BLK 9: DISTRIBUTION STATEMENT C: Distribution authorized to US Government agencies and their contractors. Other requests for this document shall be referred to WNZEA.

BLK 14: Documents shall be provided via electronic media utilizing standard Microsoft Office applications to the e-mail addresses below.

Notification of submission shall be provided to the PCO via e-mail.

AFLCMC/WNZEA: Ashkan Seratnahaei@us.mil.mil (ENG) AFLCMC/WNKAAB: Kathryn.Canady@us.af.mil (PCO)

15. Total

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

Ashkan Seratnahaei April 2, 2015

DD FORM 1423-1, Feb 2001 Previous editions are obsolete Page 1 of 1 Pages c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USAF, cn=ROZEBOOM.VICTOR.E.JR.1026994850

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