N3904026Q5443 Exhibit A.docx
DOCX document 28 KB Posted
- Attached to
- Brand Name Hose Assemblies PNSY Federal contract opportunity
- Solicitation number
- N3904026Q5443
About this file
This is a Contract Data Requirements List (DD Form 1423) attachment specifying quality assurance and documentation requirements for hose assemblies under solicitation N3904026Q5443. The document outlines five separate data requirement entries (sequence numbers A002AA, A004AA, A006AA, A008AA, and A010AA), each requiring a Certificate of Hydrostatic Test to be submitted with material shipments. Each entry mandates one test report per unit for a quantity of 10 units, with distribution via mail to the technical office (2310.1) and no DD Form 250 required. All test documentation must be submitted with the initial material shipment.
The document also includes a Certificate of Compliance template requiring the contractor's quality assurance official to attest that all furnished items comply with contract requirements. The certificate must identify the material by lot, batch, part number, NSN/LSN, manufacturer part number, serial number, drawing number, and manufacturer heat numbers. The vendor is responsible for conducting all required tests, analyses, inspections, and examinations per contract specifications, and all inspection and test reports must accompany the signed compliance statement to ensure traceability to each contract item and demonstrate full compliance with all contractual requirements.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| N3904026Q5443 U0001 Combined Synopsis Solicitation.docx | DOCX document | |
| N3904026Q5443 Combined Synopsis Solicitation.docx | DOCX document | |
| N3904026Q5443 Attachment 2 - LSJ Redacted.pdf | ||
| N3904026Q5443 Attachment 1 - TCs.docx | DOCX document |
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Text version
CONTRACT __________________
PAGE _______
ATTACHMENT 1 TO EXHIBIT A (DD FORM 1423)
(ADP DD FORM 1423 (MECHANIZED EQUIVALENT) PER DAR CLAUSE 16-815)
CONTRACT DATA REQUIREMENTS LIST
| SYSTEM/ITEM: ALL HOSE ASSEMBLIES | CATEGORY ____________ | |
| ITEM NO | CONTRACTOR |
| 01 | SEQ NO | A002AA | |||
| 02 | DATA DESC | CERTIFICATE OF HYDROSTATIC TEST | |||
| 03 | SUBTITLE | ||||
| 04 | DID NUMBER | PER ATTACHMENT 1 TO EXHIBIT A | |||
| 05 | CONTRACT REF | PARA. C.4.1. | |||
| 06 | TECH OFFICE | 2310.1 | |||
| 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 SHIPMENT | |||
| 13 | DATE SUB SUBM | ||||
| 14 | DISTRIBUTION | 410 | __/ | 0 VIA MAIL (N0 DD 250 REQD) | |
| 15 | TOTAL | __ | |||
| 16 | REMARKS | ONE TEST REPORT PER UNIT; QTY (10) |
SEQ. NO. A002AA
| PREPARED BY ________________________________________________ | DATE__________________ |
| APPROVED BY ________________________________________________ | DATE__________________ |
DD FORM 1423
CONTRACT __________________
PAGE _______
EXHIBIT A
| SYSTEM/ITEM: ALL HOSE ASSEMBLIES | CATEGORY ____________ | |
| ITEM NO | CONTRACTOR |
| 01 | SEQ NO | A004AA | |||
| 02 | DATA DESC | CERTIFICATE OF HYDROSTATIC TEST | |||
| 03 | SUBTITLE | ||||
| 04 | DID NUMBER | PER ATTACHMENT 1 TO EXHIBIT A | |||
| 05 | CONTRACT REF | PARA. C.4.1. | |||
| 06 | TECH OFFICE | 2310.1 | |||
| 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 SHIPMENT | |||
| 13 | DATE SUB SUBM | ||||
| 14 | DISTRIBUTION | 410 | __/ | 0 VIA MAIL (N0 DD 250 REQD) | |
| 15 | TOTAL | __ | |||
| 16 | REMARKS | ONE TEST REPORT PER UNIT; QTY (10) |
SEQ. NO. A004AA
| PREPARED BY ________________________________________________ | DATE__________________ |
| APPROVED BY ________________________________________________ | DATE__________________ |
| SYSTEM/ITEM: ALL HOSE ASSEMBLIES | CATEGORY ____________ | |
| ITEM NO | CONTRACTOR |
| 01 | SEQ NO | A006AA | |||
| 02 | DATA DESC | CERTIFICATE OF HYDROSTATIC TEST | |||
| 03 | SUBTITLE | ||||
| 04 | DID NUMBER | PER ATTACHMENT 1 TO EXHIBIT A | |||
| 05 | CONTRACT REF | PARA. C.4.1. | |||
| 06 | TECH OFFICE | 2310.1 | |||
| 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 SHIPMENT | |||
| 13 | DATE SUB SUBM | ||||
| 14 | DISTRIBUTION | 410 | __/ | 0 VIA MAIL (N0 DD 250 REQD) | |
| 15 | TOTAL | __ | |||
| 16 | REMARKS | ONE TEST REPORT PER UNIT; QTY (10) |
SEQ. NO. A006AA
| PREPARED BY ________________________________________________ | DATE__________________ |
| APPROVED BY ________________________________________________ | DATE__________________ |
| SYSTEM/ITEM: ALL HOSE ASSEMBLIES | CATEGORY ____________ | |
| ITEM NO | CONTRACTOR |
| 01 | SEQ NO | A008AA | |||
| 02 | DATA DESC | CERTIFICATE OF HYDROSTATIC TEST | |||
| 03 | SUBTITLE | ||||
| 04 | DID NUMBER | PER ATTACHMENT 1 TO EXHIBIT A | |||
| 05 | CONTRACT REF | PARA. C.4.1. | |||
| 06 | TECH OFFICE | 2310.1 | |||
| 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 SHIPMENT | |||
| 13 | DATE SUB SUBM | ||||
| 14 | DISTRIBUTION | 410 | __/ | 0 VIA MAIL (N0 DD 250 REQD) | |
| 15 | TOTAL | __ | |||
| 16 | REMARKS | ONE TEST REPORT PER UNIT; QTY (10) |
SEQ. NO. A008AA
| PREPARED BY ________________________________________________ | DATE__________________ |
| APPROVED BY ________________________________________________ | DATE__________________ |
| SYSTEM/ITEM: ALL HOSE ASSEMBLIES | CATEGORY ____________ | |
| ITEM NO | CONTRACTOR |
| 01 | SEQ NO | A010AA | |||
| 02 | DATA DESC | CERTIFICATE OF HYDROSTATIC TEST | |||
| 03 | SUBTITLE | ||||
| 04 | DID NUMBER | PER ATTACHMENT 1 TO EXHIBIT A | |||
| 05 | CONTRACT REF | PARA. C.4.1. | |||
| 06 | TECH OFFICE | 2310.1 | |||
| 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 SHIPMENT | |||
| 13 | DATE SUB SUBM | ||||
| 14 | DISTRIBUTION | 410 | __/ | 0 VIA MAIL (N0 DD 250 REQD) | |
| 15 | TOTAL | __ | |||
| 16 | REMARKS | ONE TEST REPORT PER UNIT; QTY (10) |
SEQ. NO. A010AA
| PREPARED BY ________________________________________________ | DATE__________________ |
| APPROVED BY ________________________________________________ | DATE__________________ |
CONTRACT/SOLICITATION ________________________________________________________________ ITEM ___________________________________________ (DATE 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".
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.
CERTIFICATE OF COMPLIANCE
COMPANY NAME
MATERIL IDENTIFICATION (COMPLETE APPLICABLE ITEMS)
CONTRACT NO. ______________ ORDER NO. ________________ ITEM NO. ____________________ NATIONAL/LOCAL STOCK NO. NSN/LSN ____________________________________________________ MANUFACTURER’S PART NO. _____________________________________________________________ MANUFACTURER’S SERIAL NO. ___________________________________________________________ DRAWING AND PIECE NO. _________________________________________________________________
MANUFACTURER’S LOT/HEAT NOS. AS MARKED ON THE MATERIAL _________________________
ALL INSPECTIONS AND TEST REPORTS REQUIRED BY ATTACHMENT I TO EXHIBIT A (DD FORM 1423) FOR TRACEABILITY TO EACH CONTRACT ITEM MUST ACCOMPANY THIS SIGNED STATEMENT:
THE INSPECTION AND TEST REPORTS (AS APPLICABLE) PROVIDED REPRESENT THE ACTUAL ATTRIBUTES OF THE ITEMS FURNISHED ON THIS CONTRACT AND INDICATE FULL COMPLIANCE WITH ALL CONTRACT REQUIREMENTS. I ATTEST ALL ITEMS FURNISHED ON THIS CONTRACT ARE IN FULL COMPLIANCE WITH ALL CONTRACT REQUIREMENTS.
| SIGNATURE ___________________________________________________ | DATE _______________ | |
| QUALITY ASSURANCE OFFICIAL |
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