Exhibit_A.pdf

CONTRACT

PRINTED 08/19/2018 PAGE

EXHIBIT A

(ADP DD FORM 1423 (MECHANIZED EQUIVALENT) PER DAR CLAUSE 16-815)

CONTRACT DATA REQUIREMENTS LIST

SYSTEM/ITEM TANK CATEGORY

ITEM NO 001 CONTRACTOR

01 SEQ NO A001

02 DATA DESC CERTIFICATE OF COMPLIANCE

03 SUBTITLE

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.4.1

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB

SUBM

14 DISTRIBUTION 530 1/ 0 VIA MAIL (N0 DD 250 REQD)

15 TOTAL 1

16 REMARKS

SEQ. NO. A001

PREPARED BY DATE

APPROVED BY DATE

DD FORM 1423

EXHIBIT A

(ADP DD FORM 1423 (MECHANIZED EQUIVALENT) PER DAR CLAUSE 16-815)

CONTRACT DATA REQUIREMENTS LIST

SYSTEM/ITEM TANK CATEGORY

ITEM NO 002 CONTRACTOR

01 SEQ NO A002

02 DATA DESC HYDROSTATIC TEST CERTIFICATION

03 SUBTITLE

04 DID NUMBER PER ATTACHMENT 1 TO EXHIBIT A

05 CONTRACT REF PARA. C.4.2

06 TECH OFFICE 2380.2

07 DD 250 REQ DD

08 APP CODE

09 IAC INPUT

10 FREQUENCY O-TIME

11 AS OF DATE

12 DATE 1ST SUBM WITH MATERIAL

13 DATE SUB SUBM

14 DISTRIBUTION 530 1/ 0 VIA MAIL (N0 DD 250 REQD)

15 TOTAL 1

16 REMARKS

SEQ. NO. A002

PREPARED BY DATE

APPROVED BY DATE

DD FORM 1423

ATTACHMENT 1 TO EXHIBIT A (DD FORM 1423)

CONTRACT/SOLICITATION __________________________

ITEM _____________ (DATA FOR ITEM __________________________)

REQUIRED CERTIFICATION

A. CERTIFICATION SHALL BE SUPPLIED WITH EACH SHIPMENT OF MATERIAL.

CERTIFICATION (CERTIFICATE OF COMPLIANCE) SHALL BE SUPPLIED AS OUTLINED IN

PARAGRAPH B. THE VENDOR IS LIABLE FOR CONDUCTING ALL TESTS, ANALYSES,

INSPECTIONS, AND EXAMINATIONS, ETC., AS SPECIFIED BY THE CONTRACT AND

SPECIFICATIONS WHETHER CERTIFICATIONS ARE REQUIRED OR NOT.

CERTIFICATE OF COMPLIANCE (PROVIDE THE FOLLOWING VERBATIM STATEMENT OR

COMPLETE THE OPTIONAL FORM AT THE END OF THIS PART):

"I ATTEST ALL ITEMS FURNISHED ON THIS CONTRACT ARE IN FULL COMPLIANCE WITH

ALL CONTRACT REQUIREMENTS. THE INSPECTION AND TEST REPORTS PROVIDED

REPRESENT THE ACTUAL ATTRIBUTES OF THE ITEMS FURISHED ON THIS CONTRACT AND

INDICATE FULL COMPLIANCE WITH ALL APPLICABLE SPECIFICATION AND CONTRACT

REQUIREMENTS.”

B. CERTIFICATION SHALL BE SUPPLIED PER THE FOLLOWING INSTRUCTIONS:

1. THE CERTIFICATION OF COMPLIANCE SHALL CONTAIN THE SIGNATURE AND TITLE OF

THE VENDOR OFFICIAL DESIGNATED RESPONSIBLE FOR QUALITY ASSURANCE.

2. THE MATERIAL IDENTIFICATION (E.G. LOT, BATCH, PART #, ETC.) SHALL BE INCLUDED ON

THE CERTIFICATE OF COMPLIANCE AND HYDROSTATIC TEST CERTIFICATION.

ATTACHMENT 1 TO EXHIBIT A (DD FORM 1423)

CERTIFICATE OF COMPLIANCE

COMPANY NAME

MATERIAL IDENTIFICATION (COMPLETE APPLICABLE ITEMS)

CONTRACT NO. -___________________ ORDER NO. _________________

ITEM NO. _______________

LOCAL STOCK NUMBER: ______________________

MANUFACTURER'S PART NUMBER ______________

"I ATTEST ALL ITEMS FURNISHED ON THIS CONTRACT ARE IN FULL COMPLIANCE WITH

ALL CONTRACT REQUIREMENTS. THE INSPECTION AND TEST REPORTS PROVIDED

REPRESENT THE ACTUAL ATTRIBUTES OF THE ITEMS FURISHED ON THIS CONTRACT AND

INDICATE FULL COMPLIANCE WITH ALL APPLICABLE SPECIFICATION AND CONTRACT

REQUIREMENTS.”

SIGNATURE _______________________________ DATE ________

QUALITY ASSURANCE OFFICIAL