A001_CDRL1_REPORT.pdf

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Attached to
ELT Beacon Distress
Solicitation number
FA8539-17-R-0026
Issued by

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Counterfeit Prevention Plan

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

The 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Executive Services Directorate (0704-0188).

Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. 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

A

C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

ELT/ DISTRESS BEACON

E. CONTRACT / PR NO.

FD20601700074

F. CONTRACTOR

ACR Electronics Inc.,

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Counterfeit Prevention Plan

3. SUBTITLE

n/a

4. AUTHORITY

DI-MISC-81832

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

FD2060-17-00074

6. REQUIRING OFFICE

407 SCMS/GUEA

7. DD 250 REQ

LT

8. APP CODE

N/A

9. DIST STATEMENT

REQUIRED

D

10. FREQUENCY

ASREQ

11. AS OF DATE

ASREQ

12. DATE OF FIRST

SUBMISSION

ASREQ

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Pham, Dong XNAME: 16 FEB 2017DATE:

NSN: 5821-01-561-9503

Block 10-13: Report within 30 calendar days after any counterfeit part discovery.

Block 14: Ship to for Acceptor invoice DoDAAC FA8539, for Inspection and Acceptance.

The notification email will be provided to the Government Program Manager, or Engineer

PM: Anthony Simmons, Email: anthony.simmons.12@us.af.mil

Engineer: Dong Pham, Email: dongx.pham.1@us.af.mil

COORDINATORS:

235 Byron St. STE 19A Robins AFB, GA 31098 ATTN: Anthony Simmons

0 1 0

235 Byron St., STE 19A Robins AFB, GA 31098 ATTN: Dong Pham

0 1 0

0 2 015. TOTAL

G. PREPARED BY

Griffis, Rebecca L

407 SCMS / GULBD

478-926-1860

H. DATE

16 FEB 2017

I. APPROVED BY

//DIGITALLY SIGNED//

PHAM.DONG.X.1239717078

407 SCMS / GUEAN 478-926-9814 / 468-9814

J. DATE

16 FEB 2017

Page 1 of 1DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 24 Feb 2017

PREVIOUS EDITION MAY BE USED.

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