J.1(b)_Attachment_8_DD1419.pdf

DOD INDUSTRIAL PLANT EQUIPMENT REQUISITION

REQUISITION NUMBER Form Approved

OMB No. 0704-0246 Expires Dec 31, 1999

SECTION I - ITEM DESCRIPTION

1. COMMODITY CODE 2. MANUFACTURER 3. MODEL NUMBER

4. STOCK NUMBER 5. POWER CODE 6. ESTIMATED COST 7. PHYSICAL INSPECTION

REQUIRED (X one)

YES NO

8. PROCUREMENT SPECIFICATION

ATTACHED (X one)

YES NO

9. DESCRIPTION

CONTINUED UNDER REMARKS SECTION YES NO

SECTION II - ROUTING AGENCY/FACILITY/CONTRACTOR

10. NAME AND ADDRESS (Include ZIP Code) 11. CONTRACT NUMBER 12. DATE (YYYYMMDD) 13. COMMAND CODE

14. PROGRAM (X one)

MILITARY CONTRACTOR

15. INTENDED USE 16. DATE ITEM REQUIRED AT

DESTINATION (YYYYMMDD)

17. DATE CERT. N/A

REQUIRED

(YYYYMMDD)

18. PRIORITY

19. BASIS FOR AUTHORIZATION (X one)

PRODUCTION MOBILIZATION

REPLACEMENT

20. PROCUREMENT PLANNED (X one)

YES NO (If "YES," cite Appropriation)

21. REBUILD/OVERHAUL

CANDIDATE

YES

22. TYPED NAME AND TITLE OF REQUESTING OFFICIAL 24. DATE (YYYYMMDD)23. SIGNATURE OF REQUESTING OFFICIAL

25. CERTIFICATION OF NEED BY ADMINISTERING ACTIVITY a. ADMINISTERING OFFICE CODE

b. NAME AND ADDRESS (Include ZIP Code) d. DATE (YYYYMMDD)c. TYPED NAME AND SIGNATURE OF PRODUCTION

REPRESENTATIVE

f. DATE (YYYYMMDD)e. SIGNATURE OF ADMIN. CONTRACTING OFFICER

SECTION III - APPROVAL AUTHORITY

26. NAME AND ADDRESS (Include ZIP Code) 27. TITLE, SYMBOL AND TELEPHONE NO. OF APPROVING OFFICIAL

29. DATE (YYYYMMDD)28. TYPED NAME & SIGNATURE OF APPROVING OFFICIAL

SECTION IV - ALLOCATION AND AUTHORITY TO INSPECT (To be completed by DSCR)

30. COMMODITY CODE 31. I.D./GOVERNMENT TAG NUMBER 32. DESCRIPTION (See attached copy of DD Form 1342, dated)

33. PRESENT LOCATION (Name, address and ZIP Code) 34. SHIPPED TO (Name, address and ZIP Code)

35. ESTIMATED TIME REQUIRED FOR SHIPMENT FROM DATE OF ACCEPTANCE (Enter number of days)

a. AS IS CONDITION b. TEST REQUIRED c. REPAIR REQUIRED d. REPAIR/OVERHAUL REQUIRED e. STANDARD ATTACHMENTS REQUIRED

37. DATE (YYYYMMDD)36. TYPED NAME AND SIGNATURE OF ALLOCATING OFFICIAL 38. DATE OFFER EXPIRES (YYYYMMDD)

SECTION V - NON-AVAILABILITY CERTIFICATE (To be completed by DSCR)

The item described in Section I of this form has been screened by DSCR against the idle inventory of the Department of Defense and it is hereby certified as not available or cannot be delivered on or before the date specified in Section II (Item 14). Procurement action resulting from this Certification of Non-Availability must be initiated within 45 calendar days of the date included in this Section (Item 40) or complete rescreening is required. Equipment offered by DSCR in Section IV must be considered if the supplier cannot deliver new equipment before expiration of the period specified in Section IV (Item 33).

39.

41. DATE CERTIFICATE

ISSUED (YYYYMMDD)

40. TYPED NAME AND SIGNATURE OF CERTIFYING OFFICIAL 42. DATE CERTIFICATE

EXPIRES (YYYYMMDD)

43. CERTIFICATE NUMBER

DD FORM 1419, JAN 1997 (EG) PREVIOUS EDITION MAY BE USED. Designed using Perform Pro, WHS/DIOR, Jan 97

The public reporting burden for this collection of information is estimated to average 1.5 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, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0246), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 THIS ADDRESS. RETURN COMPLETED FORM TO

DEFENSE SUPPLY CENTER RICHMOND, ATTN: JH, 8000 JEFFERSON DAVIS HIGHWAY, RICHMOND, VA 28297-5100

SECTION VI - CERTIFICATE OF ACCEPTANCE

45. TYPED NAME AND TITLE OF CERTIFYING OFFICIAL 47. DATE (YYYYMMDD)

a. HAS BEEN PHYSICALLY INSPECTED AND IS ACCEPTABLE b. IS ACCEPTABLE WITHOUT PHYSICAL INSPECTION

44. THE ITEM ALLOCATED IN SECTION IV OF THIS FORM (X as applicable)

c. IS ACCEPTED UNDER ONE OF THESE CONDITIONS:

(1) AS IS CONDITION (2) REPAIR REQUIRED (3) TEST REQUIRED (4) REBUILD/OVERHAUL REQUIRED

(5) OTHER

d. IS NOT ACCEPTABLE (A complete description of conditions making item unacceptable must be stated under REMARKS below)

46. SIGNATURE OF CERTIFYING OFFICIAL

SECTION VII - SPECIAL SHIPPING INSTRUCTIONS

48. SHIP TO (Include ZIP Code) 49. FOR TRANSSHIPMENT TO (Include ZIP Code)

50. MARK FOR

d. PAYING OFFICE/ACTIVITY NAME AND ADDRESS (Include ZIP Code)51. APPROPRIATION CHARGEABLE FOR

a. PACKING/CRATING/HANDLING

b. TRANSPORTATION

c. OTHER

52. SPECIAL DISTRIBUTION OF SHIPPING DOCUMENTS AND OTHER INSTRUCTIONS

53. REMARKS

SECTION VIII - REMARKS

DD FORM 1419 (BACK), JAN 1997