SMW_REPORT.pdf

SURPLUS MATERIEL WORKSHEET

DATE

10 JAN 2022

I. REQUEST FOR EVALUATION

NSN

2840014491573NZ

PART NUMBER

4084071-01

CAGE

77445

APPLICATION

F100

IMS

Ashcroft, Craig A

OFFICE SYMBOL

421 SCMS / GUMAD

PHONE

405-734-5381

SURPLUS MATERIEL MAY BE AVAILABLE TO FULFILL THE GOVERNMENT'S NEEDS FOR THIS ITEM. AS A RESULT, AN EVALUATION MUST BE PERFORMED

IAW AFMC FAR SUPPLEMENT PART 5352.

THE EVALUATION ON THIS ITEM INDICATES SURPLUS MATERIEL WILL BE CONSIDERED IN THE FOLLOWING TYPES / CATEGORIES

II. EVALUATION CRITERIA (For types/categories deemed acceptable)

ACCEPT-

ABLE (Y/N)

P/N AND

MFG

VERIFI-

CATION

PRIOR

GOV'T

OWNER-

SHIP

100% END

ITEM

INSPECT

TEST AND

VERIFI-

CATION

VERIFI-

ABLE

DIMEN-

SIONS

LOCATION

INSPEC-

TION

TESTING

INITIAL

ACCEPT-

ABILITY

ITEMS

OVERHAUL

AND

CERTIFI-

CATION

OTHER

(Explain in Remarks)

Y X X X

N

N

N

N

N

N

N

G O V T

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

C O M M L

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

SURPLUS EVALUATION CRITERIA (If Section 11a. indicates surplus materiel may be considered). (Fill in blanks as appropriate)

PART NUMBER VERIFICATION 77445(AFMCFARS 5352.211-9011) MFG 4084071-01P/N

PRIOR GOVERNMENT OWNERSHIP (AFMCFARS 5352.211-9015)

100% END ITEM INSPECTION (AFMCFARS 5352.211-9017)

TEST AND VERIFICATION (AFMCFARS 5352.211-9013) TECH ORDER NUMBER

VERIFIABLE DIMENSION (AFMCFARS 5352.211-9012) DESIGN ACTIVITY 77445

DRAWING NUMBER 4084071-01

LOCATION OF INSPECTION TESTING (AFMCFARS 5352.211-9015)

INITIAL ACCEPTABILITY ITEMS (AFMCFARS 5352.211-9014) A QUANTITY OF ITEMS WILL BE TESTED FOR INITIAL ACCEPTANCE

TEST WILL BE CONDUCTED USING THE FOLLOWING CRITERIA (and location of testing)

OVERHAUL AND CERTIFICATION (AFMCFARS 5352.211-9010)

Parts will be in original unopened package, labeled with the correct part number, NSN and original government contract number.

OTHER SPECIAL REQUIREMENTS (Explain)

REMARKS

JUSTIFICATION FOR UNACCEPTABLE SURPLUS MATERIEL

Required Information for Surplus Material Evaluation in accordance with FAR 11.302(b)

- Misrepresentation of an item by the surplus vendor shall be cause for rejection.

- Parts that cannot be traced to a US Government contract number shall be cause for rejection.

- Damage to packaging shall be cause for rejection as these parts are susceptible to corrosion.

- Any evidence of corrosion shall be cause for rejection of the entire lot.

- Rejected parts will be returned to the vendor at no cost to the government.

EVALUATOR

Shelley, Eric C

OFFICE SYMBOL

AFLCMC / LPSEA1

PHONE

405-734-0001 / 884-0001

COMPLETE DATE

12 JAN 2022

SIGNATURE

//SIGNED// Shelley, Eric C

USER TYPE

Engineer

SIGNATURE DATE

12 JAN 2022

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