AFMC-Form1-762.pdf

CONTRACT REPAIR SCREENING ANALYSIS WORKSHEET

PART I (To be completed by PMS Seller)

1. FORM INITIATION DATE

20 APR 2015

2. FORM PRIORITY

3. NSN

5996010096445CX

4. PART NUMBER

3397440-100

5. PART NUMBER CAGE CODE

82577

6. NOUN

AMPLIFIER,AUDIO FRE

7. ANNUAL REPAIR

QUANTITY

8. LATEST REPAIR COST

$5,340.0000

9. ANNUAL REPAIR

BUDGET VALUE

$53,400.00

10. FORECAST UNIT

PRICE

$13,179.0000

11. ERRC

T

12. WEAPON SYSTEM

E-3 AWACS

13. END ITEM APPLICATION

14. HISTORY

DOES ORGANIC REPAIR OR DMISA REPAIR CAPABILITY CURRENTLY EXIST? X NO YES (if yes, specify SOR)

HAS THE ITEM PREVIOUSLY BEEN CONTRACT REPAIRED?

IF YES, COMPLETE TABLE BELOW FOR LAST 5 YEARS (not to exceed last 3 contracts)

NO X YES

SOURCE NAME CAGE CONTRACT NUMBER AWARD DATE

ASTRONICS ADVANCED ELECTRONIC SYSTE 10 SEP 20143E2Y8 FA853914D00090001

ASTRONICS ADVANCED ELECTRONIC SYSTE 24 JUN 20133E2Y8 FA853912D00050001

ASTRONICS ADVANCED ELECTRONIC SYSTE 16 AUG 20113E2Y8 FA853911D00050001

ASTRONICS ADVANCED ELECTRONIC SYSTE 17 SEP 20103E2Y8 FA853910D00040001

ASTRONICS ADVANCED ELECTRONIC SYSTE 31 MAR 20093E2Y8 FA853909D00010001

15. PMS SELLER NAME

Zanders, Santae L

CODE

QAP

OFFICE SYMBOL

AFLCMC / GULBC

PHONE

478-926-5839

COMPLETION DATE

20 APR 2015

PART II (To be completed by Equipment Specialist)

16. TECHNICAL ORDERS REQUIRED X NO YES (annotate required data and availability on RDL) UNKNOWN

17. OTHER SPECIFICATIONS / SPECIAL REPAIR CRITERIA REQUIRED X NO YES (annotate required data and availability on RDL) UNKNOWN

18. X THE DATA LISTED IN RDL COMPLETED SPECIFIES THE REPAIR REQUIREMENTS OR

ADDITIONAL DATA IS REQUIRED (Coordinate with the engineer and screening office to determine information required. Document in Block 33)

19. SPECIAL TOOL / SPECIAL TEST EQUIPMENT IS X NOT REQUIRED REQUIRED REQUIRED BUT NOT AVAILABLE

SPECIAL FACILITIES ARE X NOT REQUIRED REQUIRED

GOVERNMENT FURNISHED MATERIAL IS X NOT REQUIRED REQUIRED REQUIRED BUT NOT AVAILABLE

20. EQUIPMENT SPECIALIST NAME

Foster, Robert F

CODE

AG

OFFICE SYMBOL

407 SCMS / GULBA

PHONE

478-926-7796

COMPLETION DATE

21 APR 2015

PART III (To be completed by Screening Technician if applicable)

21. REQUESTED ENGINEERING DATA

LISTED AND ANNOTATED ON RDL NO DATA

22. SCREENING TECHNICIAN REMARKS

23. SCREENING TECHNICIAN NAME CODE OFFICE SYMBOL PHONE COMPLETION DATE

PART IV (To be completed by the Engineer)

24. CRITICAL SAFETY ITEM

X NO YES

25. CAN THIS ITEM BE COMMERCIALLY

OVERHAULED / REPAIRED (FAR Part 12)

X NO YES

26. PRECONTRACT QUALIFICATION

REQUIRED

X NO YES (JQR/QR, SQS, Waiver)

27. RDL REQUIRED FOR

SOLICITATION

X NO YES

28. RMC / RMSC CODE

R3 / R

29. RMC / RMSC EXPIRATION DATE

21 APR 2020

30. REASON FOR OTHER THAN G CODE AND ACTION TO REMEDY

The Government does not own the data or the rights to the data needed for contract repair of this item from additional sources. It has been determined to be uneconomical to buy the data or the rights to the data. It is uneconomical to reverse engineer the item.

31. APPROVED / POTENTIAL SOURCES

CAGE

CODE DATE APPROVED

Page 1 of 2AFMC FORM 762, 20060201, V1 Version 4Generated by PRPS using Jasper Reports on 19 Aug 2015

CONTRACT REPAIR SCREENING ANALYSIS WORKSHEET

31. APPROVED / POTENTIAL SOURCES

CAGE

CODE DATE APPROVED

32. ENGINEER NAME

Sarr, Abdoulie B

CODE

N/A

OFFICE SYMBOL

407 SCMS / GUEA

PHONE

478-926-0929

COMPLETION DATE

21 APR 2015

PART V (Miscellaneous, if needed)

33. REMARKS (Remarks require Functional Responsibility / Name / Office Symbol / Phone)

Page 2 of 2AFMC FORM 762, 20060201, V1 Version 4Generated by PRPS using Jasper Reports on 19 Aug 2015