23-00816_SPRTA1-23-R-0093_with_attachments.pdf

MEMORANDUM FOR: Anna Toole

Contracts Manager

Northrop Grumman Corporation

FROM: DLA Aviation - AOBB

3001 Staff Dr., 2B95

Tinker AFB, OK 73145

SUBJECT: Letter Solicitation SPRTA1-23-R-0093 to add items onto the existing Northrop Grumman Subsumable Long

Term Contract SPRTA1-19-D-0001.

This Solicitation is issued to provide notice that the attached items will be added onto the existing Northrop Grumman

Umbrella Long Term Contract SPE4AX-18-D-9443 (subsumable contract SPRTA1-19-D-0001). This item is sole sourced to Northrop Grumman Systems Corporation (cage 78JW8).

NSN P/N Noun

1560014418522FK DAA3213A301-027 PIPE,EXHAUST

SOLE SOURCE: This item has an Acquisition Method Code (AMC) of Code 3R. Northrop Grumman is currently the only source who can manufacture this part.

Please provide pricing and delivery for the following NSN, using the best estimated quantities as a guide. Also, please provide capacity and PLT information.

CLIN NSN PART CLIN TITLE QTY DELIVERY SHIP TO

0001 (Basic

Clin – do not bid)

1560014418522FK DAA3213A301-027 BASIC CLIN

INFO – DO NOT

BID

N/A N/A N/A

0001AA N/A N/A FA Test Report 1 LO 180 days ARO FA8111

0001AB N/A N/A Material

Certification

1 LO 180 days ARO FA8111

0001AC N/A N/A Certificate of

Compliance

1 LO 180 days ARO FA8111

0001AD 1560014418522FK DAA3213A301-027 FA units 1 EA 30 Days ARO

Test Report

Approval

FA8111

0001AE 1560014418522FK DAA3213A301-027 Production Units 33 EA ARO FA approval, on or before 05

Jan 2025

SW3211

Quantities: The current required quantity is 34 ea. (33 each production quantity plus 1 each First Article)

FIRST ARTICLE IS REQUIRED IAW USAF ENGINEERING. See Attached AFMC IMT 260, 20020830, V-3 form for all performance or other characteristics which the First Articles must meet. Note: This form itself will

NOT be incorporated into any resulting contract however the requirements within the form will be.

Future orders and Ship To location are To Be Determined (TBD).

DEFENSE LOGISTICS AGENCY

AVIATION AT OKLAHOMA CITY

3001 STAFF DRIVE SUITE 2AG1 109B

TINKER AIR FORCE BASE, OKLAHOMA 73145-3015

06 April 2023

This solicitation is for New Manufactured Material only.

UID marking IAW DFARS 252.211-7003 is applicable for this NSN.

Inspection: Origin

Acceptance: Origin

Inspection/Acceptance Report: Receiving Report Required.

Quality Assurance: Higher Level Contract Quality Requirements AS9100 or ISO 9001:2008, to be cited on each order.

Buy American Act/balance of Payments Program

Requested Delivery Notes:

Delivery is TBN

First Article Test Report Ship to:

FA8111 AFLCMC LZPED

CP 405 736 7455

3001 STAFF DR BLDG 3001 STE 1AB85A

TINKER AFB OK 73145-3303

73145-3303

USA

Production Units Ship to:

SW3211

DLA DISTRIBUTION DEPOT OKLAHOMA

3301 F AVE CEN REC BLDG 506 DR 22

TINKER AFB, OK 73145-8000

USA

The terms and conditions of the Northrop Grumman Umbrella Long Term Contract SPE4AX-18-D-9443 (subsumable contract SPRTA1-19-D-0001, cage 78JW8) will apply to the addition of the listed NSN(s) onto the Long Term Contract.

This correspondence constitutes a letter solicitation as these items are intended to be ordered as firm, fixed price, against the subsumable contract SPRTA1-19-D-0001. Please respond with your pricing and delivery for the item by the solicitation closing date of 06 May 2023. If you have any further questions, please contact Ryan Newton at 405-855-3545 or ryan.newton.4@us.af.mil.

Proposals may be submitted electronically, by email, to ryan.newton.4@us.af.mil

Sincerely, //SIGNED//

RYAN NEWTON

Contracting Officer

DLA Aviation at Oklahoma City/AOBB

(405) 855-3545

ATTACHMENTS:

-Packaging Requirements, AFMC 158, 1 page

-Special Packaging Instruction, SPI F012630467, 2 pages

-Transportation Data, DD Form 1653, 4 pages

-AFMC IMT 260, 20020830, V-3, FA Requirements, 3 pages

-CDRL 1423-1 (Contract Data Requirements List) for Test/Inspection Report/Material Cert/and Cert of Compliance, 3 pages

-DID (Data Item Description) for Test/Inspection Report, 4 pages

-DID (Data Item Description) for Material Certification, 3 pages

-DID (Data Item Description) for Certificate of Compliance, 2 pages

PACKAGING REQUIREMENTS

PURCHASE INSTRUMENT NUMBER: FD20302300816-00 VERSION: 1

MIL-STD 129 REVISION: R MIL-STD 2073-1 REVISION: E

THE FOLLOWING STATEMENT IS IN COMPLIANCE WITH THE UNITED NATIONS-IMPLEMENTED RESTRICTIONS ON WOOD PACKAGING MATERIAL (WPM). THIS REQUIREMENT IS SPECIFICALLY CONCERNED WITH INVASIVE SPECIES SUCH AS THE PINEWOOD NEMATODE. WPM IS DEFINED AS WOOD PALLETS, SKIDS, LOAD BOARDS, PALLET COLLARS, WOODEN BOXES, REELS, DUNNAGE, CRATES, FRAMES, AND CLEATS. THE STATEMENT BELOW CITES THE REQUIREMENTS IN DETAIL AND COVERS LUMBER FOR BUILDING CONTAINERS AND PALLETS USED FOR DELIVERIES RESULTING IN SHIPMENTS WORLDWIDE (DIRECT, OR THROUGH AIR LOGISTICS CENTERS (ALC), CONTAINER CONSOLIDATION POINTS (CCP), OR OTHER BASES). WOODEN LUMBER, WOODEN

PALLET AND PACKAGING/CONTAINER STATEMENT:

ALL WOODEN LUMBER, WOODEN PALLET'S, AND WOODEN CONTAINERS PRODUCED ENTIRELY OR IN PART OF WOOD PACKING MATERIAL (WPM) SHALL BE CONSTRUCTED FROM DEBARKED WOOD IN ADDITION TO THE APPLICATION OF HEAT-TREATED (HT) MATERIAL (HT TO 56 DEGREES CENTIGRADE OR 133 DEGREES FAHRENHEIT FOR 30 MINUTES). CERTIFICATION/MARKING IS REQUIRED BY AN ACCREDITED AGENCY RECOGNIZED BY THE AMERICAN LUMBER STANDARDS COMMITTEE (ALSC). FOR REFERENCE DOCUMENTATION, SEE LATEST REVISION OF "INTERNATIONAL STANDARDS FOR PHYTOSANITARY MEASURES" (ISPM)NO.15), "REGULATION OF WOOD PACKAGING MATERIAL IN INTERNATIONAL TRADE."

PACRN: PACKAGING REQUIREMENT: PRESERVATION LEVEL: PACKAGING LEVEL: SPI: SPI REV: SPI DATE:

AAC MIL-STD-2073-1 / SPI MIL B F012630467 A 94174 - 23 JUN 1994

ITEM(S):

1560014418522FK 1560DTH2300E3FK 1560DTH2300E4FK 1560DTH2300E5FK 1560DTH2300E6FK

CODED DATA:

QUP ICQ

PRES

METH CD

PRES

MTL

WRAP

MTL

CUSH

DUNN CT

UNIT

CONT

INT

CONT UCL

SPEC

MKG

UNIT PACK

WEIGHT

UNIT PACK

LENGTH

UNIT PACK

WIDTH

UNIT PACK

DEPTH

UNIT PACK

CUBE OPI

ADDITIONAL PACKAGING AND CONTAINER MARKING REQUIREMENTS:

SUPPLEMENTAL PACKAGING INSTRUCTION TEXT:

VENDOR PACKAGING INSTRUCTIONS:

Military Packaging and Marking Items shall be packaged in accordance with MIL-STD-2073-1, Standard Practice for Military Packaging. Shipping and storage markings shall be in accordance with MIL-STD-129, Standard Practice for Military Marking.

Shipping Container Marking Shipping containers shall be marked meeting the following criteria: (a) MIL-STD-129, Standard Practice for Military Marking. (b) Additional marking and/or bar coding requirements exceeding those of MIL-STD-129 (e.g., unit serial numbers, original equipment manufacturers (OEM) name, or OEM model number, as specified on the AFMC Form 158.

ORGANIZATION / OFFICE SYMBOL:

406 SCMS / GULAA

PACKAGING SPECIALIST:

Strain, Verlisher M

PHONE NUMBER:

405-582-9697 / 852-9697

SIGNATURE:

//SIGNED//Strain, Verlisher M

DATE:

23031 - 31 JAN 2023

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TRANSPORTATION DATA FOR SOLICITATIONS

COMMODITY: See Continuation

PURCHASE INSTRUMENT NUMBER:

FD20302300816-00

DATE INITIATED:

31 JAN 2023

STOCK NUMBER: See Continuation

X ORIGIN DESTINATION OTHER DATA / FIRST ARTICLE F.O.B. DESTINATION(Specify)

F.O.B. TERMS RECOMMENDED AS BEST SUITED FOR THIS PROCUREMENT

TRANSPORTATION PROVISIONS / CLAUSES FAR CITATION

F.O.B. Origin 52.247-29 Freight Classification Description 52.247-53 Contact DCMA Transportation Contact DCMA Transportation on ALL "DCMA Administered" contracts prior to shipment for shipping instructions using the DCMA Shipment Instruction Request (SIR) eTool System, at http://www.dcma.mil <http://www.dcma.mil/> for ALL FOB:

Origin, Foreign Military Sales (FMS), and FOB: Destination OCONUS/Export movements to obtain the appropriate DOD regulatory clearances, shipping documentation and instructions from your cognizant DCMA Transportation Office. If you are new to DCMA, and do not already have a SIR eTool account, you will first need to request an account via DCMA External Web Access Management (EWAM) application which can be accessed at http://www.dcma.mil. If you need additional assistance, email DCMA Transportation Group at: Transportation.Division@dcma.mil. Do not move any freight to a water or aerial port prior to contacting DCMA or it will become frustrated. Failure to contact the responsible DCMA may result in vendor incurring additional expenditures.

Vendor Transportation Instructions

IAW BASIC CONTRACT FD20302300816-00

TACRN:

AAA

TRANSPORTATION FUNDS INFORMATION:

Purchase Instrument Line LOA: 97X4930.FC04 643 47GT 15B02A 01N000 00000 GGGTTT 503000 F03000 FSR: 013352 PSR: K31826

First Destination Transportation Account Code: FRS2

Miscellaneous Obligation / Reimbursement Document:

Second Destination Transportation Account Code:

FMS LOA:

Additional Funding Information:

ITEM / SHIP TO(s):

NSN / Pseudo NSN: 1560DTH2300E4FK

Purchase Instrument Line Item Number: 0003

Ship to (DoDAAC / MAPAC): FA8111

Mark For: FIRST ARTICLE MONITOR

Ship To (Address): FA8111 AFLCMC LZPED

3001 STAFF DR BLDG 3001 STE 1AB85A

TINKER AFB OK 73145-3303

73145 - 3303

USA

WPOD:

APOD:

BBP / CCP:

RIC: 0

Requisition Number:

Supplemental Address:

FMS Case:

CP 405 736 7455

Ship To (Remarks):

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NSN / Pseudo NSN: 1560DTH2300E5FK

Purchase Instrument Line Item Number: 0004

Ship to (DoDAAC / MAPAC): FA8111

Mark For: FIRST ARTICLE MONITOR

Ship To (Address): FA8111 AFLCMC LZPED

3001 STAFF DR BLDG 3001 STE 1AB85A

TINKER AFB OK 73145-3303

73145 - 3303

USA

WPOD:

APOD:

BBP / CCP:

RIC: 0

Requisition Number:

Supplemental Address:

FMS Case:

CP 405 736 7455

Ship To (Remarks):

NSN / Pseudo NSN: 1560DTH2300E6FK

Purchase Instrument Line Item Number: 0005

Ship to (DoDAAC / MAPAC): FA8111

Mark For: FIRST ARTICLE MONITOR

Ship To (Address): FA8111 AFLCMC LZPED

3001 STAFF DR BLDG 3001 STE 1AB85A

TINKER AFB OK 73145-3303

73145 - 3303

USA

WPOD:

APOD:

BBP / CCP:

RIC: 0

Requisition Number:

Supplemental Address:

FMS Case:

CP 405 736 7455

Ship To (Remarks):

EVALUATION OF PORT BID OR PROPOSAL:

SOLICITATION DATA NOTES:

OTHER TRANSPORTATION DATA:

TACRN:

AAB

TRANSPORTATION FUNDS INFORMATION:

Purchase Instrument Line LOA: 97X4930.FC04 643 47GT 15B02A 01N000 00000 GGGTTT 503000 F03000 FSR: 013352 PSR: K31826

First Destination Transportation Account Code: FRS2

Miscellaneous Obligation / Reimbursement Document:

Second Destination Transportation Account Code:

FMS LOA:

Additional Funding Information:

ITEM / SHIP TO(s):

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NSN / Pseudo NSN: 1560014418522FK

Purchase Instrument Line Item Number: 0001

Ship to (DoDAAC / MAPAC): SW3211

Mark For: ACCT 09

Ship To (Address): DLA DISTRIBUTION DEPOT OKLAHOMA

TINKER AFB OK 73145-8000

73145 - 8000

USA

WPOD:

APOD:

BBP / CCP:

RIC: 1

Requisition Number:

Supplemental Address:

FMS Case:

3301 F AVE CEN REC BLDG 506 DR 22

Ship To (Remarks):

NSN / Pseudo NSN: 1560014418522FK

Purchase Instrument Line Item Number: 0002

Ship to (DoDAAC / MAPAC): SW3211

Mark For: ACCT 09

Ship To (Address): DLA DISTRIBUTION DEPOT OKLAHOMA

TINKER AFB OK 73145-8000

73145 - 8000

USA

WPOD:

APOD:

BBP / CCP:

RIC: 1

Requisition Number:

Supplemental Address:

FMS Case:

3301 F AVE CEN REC BLDG 506 DR 22

Ship To (Remarks):

EVALUATION OF PORT BID OR PROPOSAL:

SOLICITATION DATA NOTES:

OTHER TRANSPORTATION DATA:

TACRN:

AAC

TRANSPORTATION FUNDS INFORMATION:

Purchase Instrument Line LOA: 97X4930.FC04 643 47GT 15B02A 01N000 00000 GGGTTT 503000 F03000 FSR: 013352 PSR: K31826

First Destination Transportation Account Code: FRS2

Miscellaneous Obligation / Reimbursement Document:

Second Destination Transportation Account Code:

FMS LOA:

Additional Funding Information:

ITEM / SHIP TO(s):

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NSN / Pseudo NSN: 1560DTH2300E3FK

Purchase Instrument Line Item Number: 0006

Ship to (DoDAAC / MAPAC): TBDTBD

Mark For:

Ship To (Address):

WPOD:

APOD:

BBP / CCP:

RIC:

Requisition Number:

Supplemental Address:

FMS Case:

Ship To (Remarks):

EVALUATION OF PORT BID OR PROPOSAL:

SOLICITATION DATA NOTES:

OTHER TRANSPORTATION DATA:

NAME

Respert, Woodnell M

ORGANIZATION / OFFICE

SYMBOL

406 SCMS / GULAA

COMMERCIAL / DSN

PHONE

478-327-3412 / 497-3412

SIGNATURE

//SIGNED//Respert, Woodnell M

DATE

31 JAN 2023

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FIRST ARTICLE REQUIREMENTS 1. DATE

06 OCT 2022(AFMCI 64-110, AFMCI 23-102 and FAR Part 9, Sub Part 9.3)(Additional Instructions on Page 3)

2. PR / MIPR NUMBER 3. CAGE / REFERENCE NUMBER

1W025 / DAA3213A301-027

4. NSN

1560014418522FK

5. FIRST ARTICLE QUANTITY

THE FIRST ARTICLE IS 1 UNIT(S) OF LOT / ITEM EA

AND WILL BE: X PART OF PRODUCTION QUANTITY IN ADDITION TO PRODUCTION QUANTITY

6. ARTICLES

WILL X WILL NOT SERVE AS A MANUFACTURING STANDARD

7. LONG LEAD TIME ITEMS

REQUIRED X NOT REQUIRED

(See FAR 52.209-3 OR -4, alternate II)

8. SPECIAL REQUIREMENT/PRODUCTION FACILITIES (See FAR 52.209-3 OR -4 Alternate I)

X REQUIRED NOT REQUIRED

"The First Article offered must be manufactured at the facilities in which that item is to be produced under the contract, or if the First Article is a component not manufactured by the contractor, such component must be manufactured at the facilities in which the component is to be produced for the contract. A certification to this effect must accompany each First Article which is offered."

9. TEST / INSPECTION REQUIREMENTS

A. X CONTRACTOR TESTING

GOVERNMENT TESTING

Performance or other characteristics which the First Articles must meet are

DEFINED BY ENGINEERING DWG: DOCUMENTED IN FIRST ARTICLE INSPECTION (TEST) REPORT

B. The detailed technical requirements for First Article approval tests are contained in

ENGINEERING DWG AND GOVERNMENT EVALUATION

(Cite Spec and Para number)

C. TEST PLAN REQUIRED

Number of days for government approval / disapproval days.

D. Contractor's notification to ACO and

TINKER.FIRST.ARTICLE@US.AF.MIL

(Requesting Activity) of test time and location due 30 days prior to start of testing.

E. X TEST REPORT REQUIRED

(1) Forwarded to

AFLCMC/LZPED

FA MONITOR, DODAAC FA8111

3001 STAFF DR., STE 1AB85A

TINKER AFB, OK 73145-3041

(2) Government written notice of approval / disapproval due 90 days after receipt of contractor's report.

F. FIRST ARTICLE DELIVERY

(1) Due within 180 calendar days from date contract.

(2) Notify 30 calendar days prior to shipment.

(3) Delivered to government at

SEE BLOCK 12

(Set Forth Consignee and Address)

(4) Government written notice of approval / disapproval within 90 days after receipt of first article package.

G. Estimated cost of government testing / inspection evaluation.

$3,947.2800

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06 OCT 2022(AFMCI 64-110, AFMCI 23-102 and FAR Part 9, Sub Part 9.3)(Additional Instructions on Page 3)

10. DISPOSITION OF FIRST ARTICLES

X Approved First Articles will be forwarded to

Supply

(insert quantity) First Articles will be expended in testing. Residual components of disapproved First Articles will be returned to the contractor will be retained by pending disposition instructions from the contractor.

First Articles will be installed on aircraft/equipment to determine proper fit/function. Approved article will remain on the aircraft/equipment and will not be forwarded to USAF Supply, but will be considered part of the contract quantity.

Disapproved First Articles will be returned to the contractor will be retained by pending disposition instructions from the contractor.

On purchase requests designated as direct shipments the following disposition will apply. (NOTE: Always applicable on Foreign Military Sales (FMS)).

a. Approved First Articles will be returned to the contractor for shipment with production item.

b. Disposition of disapproved First Articles will remain the same as marked above.

X Other Disposition:

Report Only. Report will be retained by AF

11. CONDITION(S) FOR WAIVER OF FIRST ARTICLE APPROVAL

a. X Offerors who have previously furnished production quantities of the same or similar article to the prime contractor for delivery to the Government, X DoD, Air Force.

b. X Offerors currently in production of the same or similar article for a Government, X DoD, Air Force contract and who have received First Article approval under the existing contract.

c. X Offerors who have previously furnished production quantities of the same or similar articles to the Government, X DoD, Air Force, provided articles thus furnished, have exhibited satisfactory performance in service in the opinion of the Air Force.

d. X Provided not more than 36 months have elapsed since completion of the contract.

e. First Article testing will not be waived.

f. X See Remarks in block 12 below.

NOTE TO BUYER: UNDER CONDITIONS A AND C ABOVE, THE COGNIZANT ENGINEERING ACTIVITY WILL DECIDE WHETHER OR NOT THE ITEM HAS EXHIBITED SATISFACTORY PERFORMANCE IN SERVICE AND PREPARE AND RETAIN SUPPORTING DOCUMENTATION TO FULLY JUSTIFY THIS DECISION. THE BUYER MUST SOLICIT DUAL PRICES (That is, both with and without requirement for first article approval) AND MUST FURNISH THE COGNIZANT ENGINEERING ACTIVITY WITH THE FOLLOWING INFORMATION ON THE PREVIOUSLY SUPPLIED ARTICLE:

A. PROCURING OFFICE B. CONTRACT NUMBER C. DATE OF CONTRACT D. SPECIFICATION NUMBER AND REVISION

12. REMARKS

Cochran, RayAnn HNAME: 06 OCT 2022DATE:

EPUB VERSION 3: Part Number DAA3213A301-027

EPUB BLOCK 9:

C. 1. DD FORM 1423 ELIN _________________________________

2. DELIVERY DUE ______________________ CALENDAR DAYS FROM DATE OF CONTRACT

E. 1. DD FORM 1423 ELIN _________________________________

2. DUE CALENDAR DAYS FROM DATE OF CONTRACT

CERTIFICATE OF COMPLIANCE & MATERIAL CERTIFICATION REQUIRED

WAIVERS MAY BE CONSIDERED WHEN REQUESTED BY THE CONTRACTING OFFICER.

Only the ESA is authorized to determine if an item is similar, except when the items are opposites detailed on the same drawing, such as 123456-12/-13(OPPOSITE).

JUSTIFICATION STATEMENT: PER FAR 9.304(D), FIRST ARTICLE TESTING AND APPROVAL IS REQUIRED BECAUSE THE REQUIREMENTS ARE SO NOVEL OR EXACTING THAT IT IS QUESTIONABLE WHETHER THE PRODUCTS WOULD MEET THE REQUIREMENTS WITHOUT TESTING AND APPROVAL. THE ITEM REQUIRES SPECIAL TOOLING. FAILURE TO PERFORM FIRST ARTICLE TESTING AND APPROVAL WILL ALLOW DEFECTS NOT WHOLLY VISIBLE TO DAMAGE SURROUNDING PARTS OF THE WEAPON SYSTEM, INJURE PERSONNEL, AND/OR REDUCE THE OPERATIONAL LIFE OF THE ITEM.

INCLUDE REQUIREMENTS OF FAR 52.209-9018 AS SUPPLEMENTED BY ATTACHED CONTRACT DATA REQUIREMENTS LIST (CDRL)

REPORT DELIVERY DUE WITHIN 270 DAYS OF CONTRACT AWARD

-- BLK 9F(3) --

THE CONTRACTOR WILL RETAIN THE FIRST ARTICLE AND ONLY SEND THE GOVERNMENT THE TEST REPORT ACCORDING TO BLOCK 9E(1).

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06 OCT 2022(AFMCI 64-110, AFMCI 23-102 and FAR Part 9, Sub Part 9.3)(Additional Instructions on Page 3)

13. COGNIZANT ENG ORGANIZATION RESPONSIBLE FOR APPROVING TEST

(Name, Organization, Phone)

Cochran, RayAnn H

424 SCMS / GU E A A

405-736-2780

886-2780

14. COGNIZANT ENG ORGANIZATION RESPONSIBLE FOR CONDUCTING

TEST (Name, Organization, Phone)

Cochran, RayAnn H

424 SCMS / GU E A A

405-736-2780

886-2780

Page 3 of 3AFMC IMT 260, 20020830, V-3 Version 3Generated by PRPS using Jasper Reports on 07 Feb 2023

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

B-2 / Pipe, Exhaust

E. CONTRACT / PR NO.

FD20302300816

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

D

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: 31 JAN 2023DATE:

NSN: 1560-01-441-8522FK

P/N: DAA3213A301-027

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 9: DISTRIBUTION STATEMENT D: Distribution authorized to Department of Defense and U.S. DoD contractors only, Critical Technology, 1 January 2023. Refer other requests for this document to 848 SCMG/EN, Tinker Air Force Base, Oklahoma.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979 (Title 50, U.S.C., App. 2401 et seq.), as amended. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DISPOSAL and DESTRUCTION NOTICES: Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

The above Distribution Statement, Warning, Destruction Notice shall be displayed or affixed to each page of the report in a conspicuous position.

BLOCK 12: 180 days after contract award.

SEE ATTACHED DD FORM 1664, DATA ITEM DESCRIPTION.

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).

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 units 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.

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

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PREVIOUS EDITION MAY BE USED.

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:

G. PREPARED BY

Zilar, Dale N

424 SCMS / GUBAB

405-736-7976

H. DATE

31 JAN 2023

I. APPROVED BY

//ELECTRONICALLY SIGNED//

Cochran, RayAnn H

424 SCMS / GUEAA 405-736-2780 / 336-2780

J. DATE

31-JAN-23

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

TDP TM OTHER X

D. SYSTEM / ITEM

B-2 / Pipe, Exhaust

E. CONTRACT / PR NO.

FD20302300816

F. CONTRACTOR

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

Certification Data For Material

3. SUBTITLE

N/A *

4. AUTHORITY

DI-MISC-81020A/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: 31 JAN 2023DATE:

NSN: 1560-01-441-8522FK

P/N: DAA3213A301-027

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.

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 0 1 0

AFLCMC/LZPED 0 1 0

0 2 015. TOTAL

Page 2 of 3DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 07 Feb 2023

G. PREPARED BY

Zilar, Dale N

424 SCMS / GUBAB

405-736-7976

H. DATE

31 JAN 2023

I. APPROVED BY

//ELECTRONICALLY SIGNED//

Cochran, RayAnn H

424 SCMS / GUEAA 405-736-2780 / 336-2780

J. DATE

31-JAN-23

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

TDP TM OTHER X

D. SYSTEM / ITEM

B-2 / Pipe, Exhaust

E. CONTRACT / PR NO.

FD20302300816

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: 31 JAN 2023DATE:

NSN: 1560-01-441-8522FK

P/N: DAA3213A301-027

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 Drive Tinker Air Force Base, Oklahoma 73145

0 1 0

0 1 015. TOTAL

G. PREPARED BY

Zilar, Dale N

424 SCMS / GUBAB

405-736-7976

H. DATE

31 JAN 2023

I. APPROVED BY

//ELECTRONICALLY SIGNED//

Cochran, RayAnn H

424 SCMS / GUEAA 405-736-2780 / 336-2780

J. DATE

31-JAN-23

Page 3 of 3DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 07 Feb 2023

DATA ITEM DESCRIPTION I Form Approved OMB No.0704.0188

1.nTLE 2.IOENTIFICATIONNUMBER

TEST/ INSPECTION REPORT DI-NM’I-80809B

L OESCRIPTlOtVPURPOSE

3.1 The testl inspection report is used to document testl inspection results, findings, and analyses that will enable the government or contracting agency to evaluate compliance with system requirements, performance objectives, specifications, and test linspection plans.

1.APPROVALDATE 5.OFFICEOFPRIMARYRESPONSIBILITY(OPB) Ea.DTICAPPLICABLE 6b.CWIEP AppliCable

(YVMMOD)

F/AFMC-DCJP

970124

,.APPLlCAT\0NflNTER7iElAT10NSH1P

7.1 This data item description (DID) contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement

I as delineated in the contract.

I

7.2 This DID is applicable to engineering (developmental ), preliminary qualification, qualification, and acceptance testing.

7.3 This DID supersedes DI-NDTI-80809A and DI-MISC-80653

1.APPROVALLIMITATION 9a.APPLICABLEFORMS 9b.AMSCNUMBER

F7231

10,PREPARATIONlNSTRUCnONS

10.1 Format. Contractor format is acceptable.

paragraph 10.2 and its subparagraphs in a manner understanding

10.2 CQnL!aL. The test/inspection report shall

applicable.

Organize the information required by that facilitates presentation and contain the following information, as

10. 2.1 Cove. and tile uaae. The following information shall appear on the outside front :over and title page:

a. Report date.

b. Report number (contractor or government)

Contractor’ s name, address, and commercia 1 and government entity code.

Contract number and contract line item number or sequence number (if applicable)

e. ‘fvpe of test/inspection (for example. first article acceptance test, aualitv con formanc-e-inspection, d-evelopmental test-, qualification test, f Identification of item tested/inspected.

9. Date or period of test/inspection.

h. Name and address of requiring government activity.

i. Security classification, downgrading and declassifying environmental Lest) .“ information, if applicable.

(Continued on page 2 )

1.DIS77UBUTIONSTATEMEW

DISTRIBUTION STATEMRNT A : APPROVED FOR PUBLIC RELBASE; DISTRIBUTION IS UNLIMITED.

ID Form 1664,APR 89 PreviOLIsedtliomwe obsdem. Page 1 of & Pages 39123

DI-NDTI-80809B

Block 10, Preparation Instructions (continued)

10.2.2 ~. The table of contents shall identify the following:

a. The title and starting page of each major section, paragraph, and apPendix of the report.

b. The page, identifying number, and title of each illustration (for example; figure, table, photograph, chart, and drawing)

10 .2.3 -ductim. The introduction shall include the following information:

10.2 .3.1 obyectlve W. The specific test/ inspection objective (s) as specified in the contract tasking document.

10. 2.3.2 L.temls) tes~. Complete identification of the item(s) testedl inspected including the following:

a. Nomenclature.

b. National stock number.

Model number, part number t and serial number :: Type of item (for example, prototype, production item, laboratory model )

e. Serial or lot number.

f. Applicable engineering changes

9. Production item specification, if applicable.

h. Date of manufacture.

10.2 .3.3 Complete inspection requirements correlated to contractual following:

Required testl inspection parameters :: Performance requirements, acceptance or environmental criteria.

10.2.4 ~. Complete test/inspection report following:

identification of the testl requirements including the compliance limits, and summary including the

a. A brief discussion of the significant test/inspection results, ObSerVati Qns, conclusions, and recommendations covered in greater detail elsewhere in the report.

b. Proposed corrective actions and schedules for failures or problems encountered.

c. Identification of deviations, departures, or limitations encountered, referenced to the contract requirements.

d. Tables, graphs, illustrations, or charts as appropriate to simplify the summary data.

10.2.5 ~. Complete identification of all documents referenced in the test finspection report including the following, as applicable:

a. Prior testf inspection reports on the same item.

b. Test /inspection plans and procedure documents

c. Prior certifications of compliance.

d. Contractor’ s file designation where test/ inspection records are maintained.

e. Input parameters used.

The applicable issue of the documents cited therein, including their approval dates and dates of any applicable amendments, notices, and revisions, shall be as specified in the contract.

Page 2 of 4 Pages

10.2.6 ~. The body of the testlinspection report shall be as follows :

10 .2.6.1 KzZL_ + de.tlflca~.

Complete identification of each item of test equipment used in the testlinspection including the following:

a.

b.

c.

d.

e.

f.

9.

10. 2.6.2

Nomenclature.

Model number.

Serial number.

Manufacturer.

Calibration status.

Accuracy data.

Comments, if applicable.

Testlinmection kuhtv mstd.b&mn and set–w. Complete description of the physical set-up used in conducting the test/inspection to include the following:

a. Location or orientation of the item.

b. Location. orientation, or settinm of test equipment and instrumentation.

c. Location, orientation, or settings of sensors and probes

d. Location or orientation of interconnections, cables, and hoop-ups.

e. Electrical power, pneumatic, fluidic, and hydraulic requirements.

Drawings, illustrations, and photographs maY be used for clarification.

10 .2.6.3 wrocedur~. Complete description of the procedures used in conducting the test/inspection to include the following:

a. Item selection and inspection that verified suitability for test/ inspection.

b. Summarized sequence of testing/inspection steps, including a description of how the item was operated during the test/inspection, and any control conditions imposed.

10 .2.6.4 A copy of all testlinspection results and analysis to include the following:

10.2.6 .4.1 ~. The actual recorded data (for example, log book entries, oscillographs, instrument readings, plotter graphs) If the recorded data is extensive, provide it in an appendix.

10. 2.6.4.2 Test/ insQec!iion resu. Identification of all testlinspection results to include the following:

a. Matrices comparing results achieved against test/inspection objectives or requirements

b. A discussion of these matrices as to their significance, and how they compare to any prior testlinspections.

Calculation examples.

;; Discussion of anomalies, deviations, discrepancies, or failures, including their impact, causes, and proposed corrective actions The discussion shall address discrepancies between design requirements and the tested/inspected Configuration.

10. 2.6.5 Conclusicxls Test/ inspection conclusions distinguished between objective and subjective to include the following:

a. The effectiveness of the testlinspection procedures in measuring item performance.

Page 3 of 4 Pages

b. The success or failure of the item to meet required test/inspection objectives.

c. The need for repeat, additional, or alternative tests linspections.

d. The need for item redesign or further development.

e. The need for improved test/inspection procedures, techniques, or facilities.

f. The adequacy and completeness of the test/inspection requirements.

10.2 .6.6 Recommendations appropriate to the test/inspection results and conclusions including the following:

a b.

c.

d.

e.

f.

9.

h.

Acceptability of the item tested/inspected (pass or fail) Additional testing/inspection required. ,.

Redesign required.

Problem resolution.

Test/inspection procedure or facility improvements Disposition of items tested/inspected.

Documentation changes required.

Testing/ inspection improvements

10.2.7 The following certifications shall be included, .as

applicable:

10.2 .7.1 A statement that the testlinspection was performed in accordance with applicable testlinspection plans and procedures, and that the results are true and accurate. The authentication shall include the signature of the contractor personnel that performed the test(s) /inspection(s) , a contractor representative authorized to make such certification, and any government witnesses

10.2 .7.2 A statement identifying those requirements not tested/inspected or measured that were previously validated.

Include identification of the data and method employed for such validation (for example, prior test/inspection, analytical verification, equivalent item, and so on) The authentication shall include the signature of a contractor representative authorized to make such authentication and any government witness.

10.2 .7.3 A statement that the item tested/ inspected either passed or failed item acceptability requirements This authentication shall include the signature of a contractor representative authorized to make such authentication and any government witness

10.2.8 Appendices shall be used to append detailed

test/inspection daia, drawings, photographs , or other documentation too voluminous to include in the main body of the report This includes referenced documentation not previously provided by the government, and test/ inspection reports from any associated test/inspection activity that may have performed some of the testing/inspecting requirements.

Page 4 of 4 Pages

DISTRIBUTION STATEMENT A. Approved for public release. Distribution is unlimited.

DATA ITEM DESCRIPTION

Title: CERTIFICATION DATA FOR NON-NUCLEAR LEVEL I MATERIAL

Number: DI-MISC-81020A Approval Date: 20220802

AMSC Number: N10338 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: MISC-2022-005

Applicable Forms: N/A

Use/Relationship: The Certification Data for Non-Nuclear Level I Material report will provide the Government with descriptions of the minimum vendor certification data reporting requirements for chemical composition, mechanical properties, and traceability requirements for

Level I material.

This Data Item Description contains the general format, content, and intended use information for the data product generated by the specific and discrete task requirement as delineated in the contract.

This DID supersedes DI-MISC-81020.

Requirements:

1. Reference Documents: The applicable issue of the documents cited herein, including their approval dates and dates of any applicable amendments, notices, and revisions, shall be as cited in the current issue of the DODISS at the time of the solicitation.

2. Format. Format for the required certification data report are represented by the examples provided on pages 4 and 5.

3. Content: The Material certification data shall include quantitative chemical composition and mechanical properties required by specification and contract. Material certification test reports shall be traceable to the material through unique traceability codes marked on the material and on all test reports. The material traceability marking shall be maintained through all phases of fabrication and manufacturing.

4. Data Format. Material certification data shall be recorded on the testing company's letterhead or standard certification form and bear the date of testing or certification of the material, name (typed or printed), organizational title, and signature of the authorized representative of the company the testing company’s address, and contact information such as telephone number and/or email address. Signatures may be handwritten or a verifiable electronic signature. Certification data supplied to the Government shall be the original mill material certification and the testing facility who supplied the testing for the mill if the mill did not perform it. Exact photocopies of certification data are acceptable.

Source: http://assist.dla.mil -- Downloaded: 2022-10-13T14:09Z Check the source to verify that this is the current version before use.

DI-MISC-81020A

5. Certification Data Required. Certification data must represent the finished product. If the starting material or raw stock is processed in a manner that will not affect its chemical composition or mechanical properties (e.g. machining), the original mill certification is acceptable. Recertification of the mechanical properties or chemical composition is required if a metal working process, heat treatment or alloying used during fabrication alters the original condition of the material. The mechanical properties or chemical composition of the material must be re-determined and be representative of the altered condition. The altered mechanical properties or chemical composition must be within specification and be part of the certification data submitted to the government. The altered material shall be uniquely re-identified (marked), and traceable to certification data.

6. Foreign Certification. In addition to the paragraph 4 data format requirements, country of origin shall be identified. Foreign languages on the certifications must be translated into English.

The units of measure must be the same as those required by the contract or specification. Those units of measure not in conformance with the contract or specification must be converted.

Translations and conversions may be annotated on the certifications, if space permits, or placed in an addendum in the same format as the foreign certification data. Such translation or conversion shall remain traceable to the material and be identified as to origin with name, title, signature, and date of the authorized representative of the company making the translation or conversion.

7. Signature. The Certification Report shall contain the signature of the contractor’s authorized representative responsible for ensuring that the equipment being delivered/service being performed is in accordance with contract requirements. Electronic signatures are acceptable provided they meet additional requirements of this DID.

EXAMPLE OF CERTIFICATION DATA REPORT

CERTIFICATION OF TESTS

TESTING LABORATORY NAME, ADDRESS, TELEPHONE NUMBER, AND EMAIL

ADDRESS

DATE ______________

MATERIAL: Monel

TYPE: II

CONDITION: ANNEALED

CUST ORDER NO. N00104-84-M TR57

OUR ORDER NO. P034784

FINISH: Hot Finished

CLASS: A

SPEC: QQ-N-281

CHEMICAL COMP - PERCENT REV: D Am. 2

ITEM HEAT

NO

C MN SUL SI NI FE CU AL

1 A123B .016 1.06 .015 .29 64.78 1.66 31.91 .12

2 A124B .17 1.15 .013 .29 64.84 1.69 31.66 .14

MECHANICAL PROPERTIES

(.2% OFFSET)

ITEM HEAT NO. TENSILE STRENGTH YIELD STRENGTH ELONGATION

(PSI) IN 2 INCHES

1 A123B 84,300 36,300 43%

2 A124B 84,000 36,100 43%

Sampling for tests was done in accordance with QQ-N-281D Am. 2.

We hereby certify that the above test data are in accordance with the specification requirements.

Signature

Name (typed or printed) and organizational title

EXAMPLE OF CERTIFICATION DATA REPORT FROM A CENTRAL DATABASE

CERTIFICATION OF TESTS

MANUFACTURER NAME, ADDRESS, TELEPHONE NUMBER, AND EMAIL ADDRESS

DATE: ___________________

COUNTRY OF ORIGIN IS UNITED CUST ORDER NO.: N00104-08-P-FA02

KINGDOM OUR ORDER NO.: M12345

MATERIAL: CRES 304/304L CONDITION: ANNEALED

SPEC: SAE-AMS-QQ-S-763A, FED STD QQ-S-763F, ASTM A182-02

MELTING & CHEMICAL ANALYSIS MFR NAME, ANYBOROUGH, UK

MECH & METALLURGICAL TEST TEST FACILITY NAME, ANYTOWN, PA

CHEMICAL COMP — PERCENT

HEAT

NO. C Mn S Si Ni P Cr Mo Cu

X1234 .024 1.610 .028 .436 8.420 .024 18.230 .490 .349

Co N Cb Cb + Ta SN AL V Ti FE

.135 .072 .017 .017 .012 .004 .100 .003 REM

MECHANICAL PROPERTIES

HEAT TENSILE (.2% OFFSET) ELONGATION RED OF

NO. (KSI) YIELD (KSI) IN 4D AREA

X1234 92.7 41.1 51.7% 75.9%

Hardness as shipped HRB 83 Micro OK

Grain Size 7.0 Macro OK

Intergranular Corrosion OK

We hereby certify that the above test data are in accordance with the specification requirements.

Signature

End of DI-MISC-81020A

DATA ITEM DESCRIPTION

Title: Certificate of Compliance Number DI-MISC-81356A Approval Date: 20071218 AMSC Number: N9036 Limitation: N/A DTIC Applicable: No GIDEP Applicable: No Office of Primary Responsibility: NAVICP Code 8741 Applicable Forms: N/A

Use/Relationship: The Certificate of Compliance provides certification from the contractor that the materiel supplied is in full compliance with all contract requirements. This DID contains the format, content, and intended use information for the data deliverable required by the contract.

This DID supersedes DI-MISC-81356.

Requirements:

1. Format. The Certificate of Compliance shall be presented in a format similar to that of Figure 1.

2. Content. The Certificate of Compliance shall contain:

a. Contractor’s name.

b. Contractor’s address.

c. Contractor’s phone number.

d. Date.

e. Contracting Agency’s name.

f. Contract Number.

g. National Stock Number (NSN).

h. Item nomenclature.

i. A statement certifying that all items furnished on the contract are in full compliance with all specification and contract requirements.

j. Authorized personnel’s signature.

k. Authorized personnel’s printed name and title.

DI-MISC-81356A

From: ______________________ (Contractor’s name)

Address: ______________________ (Contractor’s address)

Phone Number: ________________ (Contractor’s phone number)

Date: ________________

To: _______________ (Contracting Agency)

Contract Number: _______________

National Stock Number: _______________

Item Nomenclature: ___________________

“All items furnished on this contract are in full compliance with all specification and contract requirements.”

(Signature of Authorized Personnel

(Printed Name and Title of Authorized Personnel)

Note: The recording of false, fictitious, or fraudulent statements or entries on this document may be punished as a felony under Federal Statutes.

3. End of DI-MISC-81356A

Figure 1 – Sample format for a Certificate of Compliance