1929021_CDRL1_REPORT.pdf

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 C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

AN/MPN-14K / Coupler, Rotary, Radi

E. CONTRACT / PR NO.

FD20301600771

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

First Article Inspection Test Report

4. AUTHORITY

DI-NDTI-80809B/T

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

N/A

6. REQUIRING OFFICE

AFLCMC/LZPED

7. DD 250 REQ

NO

8. APP CODE

N/A

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

1 XTIME

11. AS OF DATE

Test Day

12. DATE OF FIRST

SUBMISSION

SEE BLOCK 16

13. DATE OF SUBSEQUENT

SUBMISSION

N/A

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Zilar, Dale NNAME: 19 MAY 2016DATE:

BLOCK 7: ALL INSPECTION AND ACCEPTANCE SHALL BE AT DESTINATION UTILIZING WAWF. A

COMBINATION OF AN INVOICE AND RECEIVING REPORT SHALL BE SUBMITTED THROUGH WAWF IN

ORDER TO RECEIVE PAYMENT FOR DATA REPORTS.

BLOCK 8: GOVERNMENT WRITTEN NOTICE OF APPROVAL/DISAPPROVAL IS DUE 90 DAYS AFTER

RECEIPT OF CONTRACTOR'S REPORT.

BLOCK 12: 180 DAYS AFTER CONTRACT AWARD.

BLOCK 14: Deliveries shall be submitted on ISO-10149 compliant CD-ROM in Adobe Acrobat Portable Document Format.

Contractor format acceptable unless otherwise defined by applicable Data Item Description (DID).

SEE ATTACHED DD FORM 1664, DATA ITEM DESCRIPTION.

A. THE PURPOSE OF THE FIRST ARTICLE INSPECTION IS TO GIVE OBJECTIVE EVIDENCE THAT ALL

ENGINEERING, DESIGN AND SPECIFICATION REQUIREMENTS ARE CORRECTLY UNDERSTOOD,

ACCOUNTED FOR, VERIFIED AND RECORDED.

B. SHOW COMPLETION OF INSPECTION AND RESULTS OF INSPECTION PERFORMED TO

DEMONSTRATE THAT THE FIRST ARTICLE UNIT(S) CONFORM TO THE APPLICABLE CONTRACT

TECHNICAL REQUIREMENTS.

C. REPORT SHALL DELINEATE THE SPECIFIC RESULTS OBTAINED, THE WITNESSES, AND ANY

OTHER PERTINENT OBSERVATIONS.

D. INSPECTION RESULTS SHALL BE THE APPLICABLE VARIABLE & ATTRIBUTE DATA IN THE FORM

OF RECORDINGS, INSTRUMENT READINGS AND RELATED DATA.

E. AS APPLICABLE, THE FIRST ARTICLE INSPECTION TEST REPORT SHOULD IDENTIFY ANY

DEVIATIONS OR LIMITATIONS IN THE FIRST ARTICLE UNIT(S) INVOLVED.

DELETE PARAS: 10.2.4(a), 10.2.5, 10.2.6.2, 10.2.6.3, 10.2.6.4.2(b-d), 10.2.6.5, 10.2.6.6, 10.2.7.2 & 10.2.8

AS 9102 FORMAT OR EQUIVALENT IS ACCEPTABLE.

REMARK APPLICABLE TO HAZARDOUS ITEMS ONLY: THE TESTS REQUIRED ARE AS

SPECIFIED IN CHAPTER 9 OF THE UNITED NATIONS TRANSPORT OF DANGEROUS GOODS (ORANGE

BOOK) RECOMMENDATIONS.

COORDINATORS:

424 SCMS/GUEA

3001 Staff Drive Tinker AFB OK 73145-3033

0 1 0

AFLCMC/LZPED

ATTN: FA Monitor DoDAAC

FA8111

3001 Staff Drive, Suite

1AB85A

Tinker AFB, OK 73145-3041

0 1 0

0 2 015. TOTAL

Page 1 of 3DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 30 Jun 2016

PREVIOUS EDITION MAY BE USED.

G. PREPARED BY

Schat, Richard

424 SCMS / GUBA

405-736-7179

H. DATE

22 JUN 2016

I. APPROVED BY

//DIGITALLY SIGNED//

VENCE.ALVIN.A.1232239499

424 SCMS / GUEAA 405-736-5271 / 336-5271

J. DATE

22 JUN 2016

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

AN/MPN-14K / Coupler, Rotary, Radi

E. CONTRACT / PR NO.

FD20301600771

F. CONTRACTOR

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

Certification Data for Material

3. SUBTITLE

N/A

4. AUTHORITY

DI-MISC-81020/T

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

N/A

6. REQUIRING OFFICE

AFLCMC/LZPED

7. DD 250 REQ

NO

8. APP CODE

N/A

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

See Block 16

11. AS OF DATE

N/A

12. DATE OF FIRST

SUBMISSION

See Block 16

13. DATE OF SUBSEQUENT

SUBMISSION

N/A

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Zilar, Dale NNAME: 19 MAY 2016DATE:

BLOCK 7: ALL INSPECTION AND ACCEPTANCE SHALL BE AT DESTINATION UTILIZING WAWF. A

COMBINATION OF AN INVOICE AND RECEIVING REPORT SHALL BE SUBMITTED THROUGH WAWF IN

ORDER TO RECEIVE PAYMENT FOR DATA REPORTS.

BLOCKS 10 & 12: WITH FIRST ARTICLE SUBMITTAL.

BLOCK 14: Deliveries shall be submitted on ISO-10149 compliant CD-ROM in Adobe Acrobat Portable Document Format.

1. CONTRACTOR FORMAT AUTHORIZED, MATERIAL CERTIFICATION SHALL BE SUPPLIED WITH ALL FIRST ARTICLES. COPIES OF ORIGINAL CERTIFICATION SHALL BE PROVIDED IF THE CONTRACT IS

AWARDED TO THE ORIGINAL MANUFACTURER, AND THE ITEM SHALL BE MADE FROM THE SAME

LOT OF MATERIAL. IF A NEW LOT OF MATERIAL IS USED TO PRODUCE THE ITEM, A NEW MATERIAL

CERTIFICATION SHALL BE REQUIRED. IF THE FIRST ARTICLE IS WAIVED, THE MATERIAL

CERTIFICATION IS ALSO WAIVED.

2. CHANGES TO THE DATA ITEM DESCRIPTION:

2.1 CHANGE TITLE (BLOCK 3) TO READ CERTIFICATION DATA FOR MATERIAL.

2.2 PARAGRAPH 3.1 (FIRST LINE) DELETE THE WORDS "FOR NON-NUCLEAR LEVEL 1" AND (FOURTH

LINE) DELETE THE WORDS "LEVEL 1".

COORDINATORS:

424 SCMS/GUEA

3001 Staff Dr., Ste. 1AD2 93A Tinker AFB, OK 73145

0 1 0

AFLCMC/LZPED

FA MONITOR, DODAAC

FA8111

3001 STAFF DR., STE 1AB

85A

TINKER AFB, OK 73145-

0 1 0

0 2 015. TOTAL

G. PREPARED BY

Schat, Richard

424 SCMS / GUBA

405-736-7179

H. DATE

22 JUN 2016

I. APPROVED BY

//DIGITALLY SIGNED//

VENCE.ALVIN.A.1232239499

424 SCMS / GUEAA 405-736-5271 / 336-5271

J. DATE

22 JUN 2016

Page 2 of 3DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 30 Jun 2016

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

AN/MPN-14K / Coupler, Rotary, Radi

E. CONTRACT / PR NO.

FD20301600771

F. CONTRACTOR

1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM

Certificate of Compliance

3. SUBTITLE

N/A

4. AUTHORITY

DI-MISC-81356A

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

N/A

6. REQUIRING OFFICE

424 SCMS/GUEA

7. DD 250 REQ

NO

8. APP CODE

N/A

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

See Block 16

11. AS OF DATE

N/A

12. DATE OF FIRST

SUBMISSION

See Block 16

13. DATE OF SUBSEQUENT

SUBMISSION

N/A

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Zilar, Dale NNAME: 19 MAY 2016DATE:

BLOCK 7: ALL INSPECTION AND ACCEPTANCE SHALL BE AT DESTINATION UTILIZING WAWF. A

COMBINATION OF AN INVOICE AND RECEIVING REPORT SHALL BE SUBMITTED THROUGH WAWF IN

ORDER TO RECEIVE PAYMENT FOR DATA REPORTS.

BLOCKS 10 & 12: WITH FIRST ARTICLE SUBMITTAL.

BLOCK 14: Deliveries shall be submitted on ISO-10149 compliant CD-ROM in Adobe Acrobat Portable Document Format.

1. CONTRACTOR FORMAT AUTHORIZED, CERTIFICATE OF COMPLIANCE SHALL BE SUPPLIED WITH ALL FIRST ARTICLES. COPIES OF ORIGINAL CERTIFICATION SHALL BE PROVIDED IF THE CONTRACT IS AWARDED TO THE ORIGINAL MANUFACTURER, AND THE ITEM SHALL BE MADE FROM THE SAME LOT OF MATERIAL. IF A NEW LOT OF MATERIAL IS USED TO PRODUCE THE ITEM, A NEW MATERIAL CERTIFICATION SHALL BE REQUIRED. IF THE FIRST ARTICLE IS WAIVED, THE CERTIFICATE OF

COMPLIANCE IS ALSO WAIVED.

COORDINATORS:

424 SCMS/GUEA

3001 Staff Dr., Ste. 1AD2 93A Tinker AFB, OK 73145

0 1 0

0 1 015. TOTAL

G. PREPARED BY

Schat, Richard

424 SCMS / GUBA

405-736-7179

H. DATE

22 JUN 2016

I. APPROVED BY

//DIGITALLY SIGNED//

VENCE.ALVIN.A.1232239499

424 SCMS / GUEAA 405-736-5271 / 336-5271

J. DATE

22 JUN 2016

Page 3 of 3DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 30 Jun 2016