Form_813.pdf

SURPLUS MATERIEL WORKSHEET

DATE

13 OCT 2017

I. REQUEST FOR EVALUATION

NSN

6615013946499LG

PART NUMBER

622-0945-017

CAGE

13499

APPLICATION

C-130

IMS

Bethel, David L

OFFICE SYMBOL

409 C130 / ENB

PHONE

478-327-2636

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 X X

Y X X X X X

Y X X X X X

Y X X X X X X

Y X X X X

Y X X X X

Y X X X X

Y X X X X X

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 13499(AFMCFARS 5352.211-9011) MFG 622-0945-017P/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 T.O. 5A9-8-6-3

VERIFIABLE DIMENSION (AFMCFARS 5352.211-9012) DESIGN ACTIVITY

DRAWING NUMBER 266-6981

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

Must be exact Form, Fit, and Function (F3I) of legacy item. Item furnished must have passed the qualification tests as specified in Tech Order #589-8-6-3

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

OVERHAUL AND CERTIFICATION (AFMCFARS 5352.211-9010)

If overhauled, contractor should submit copy/scan of service tags to the government for review.

OTHER SPECIAL REQUIREMENTS (Explain)

Hardaway, Christopher JNAME: 25 OCT 2017DATE:

Overhaul and certification (AFMCFARS 5352.211-9010) Items must have been overhauled and certified by Federal Aviation Admin. licensed facility.

REMARKS

JUSTIFICATION FOR UNACCEPTABLE SURPLUS MATERIEL

Items that do not provide proof of source of manufacture, which has to be Rockwell Collins CAGE 13499, cannot be accepted. Reconditioned items that do not pass operational test procedures cannot be accepted. Overhauled &modified items that do not provide proof that the overhaul/modification was performed at a Federal Aviation Admin. licensed facility and/ or do not pass operational test procedures cannot be accepted

EVALUATOR

Hardaway, Christopher J

OFFICE SYMBOL

409 C130 / ENB

PHONE

478-926-6389 / 468-6389

COMPLETE DATE

30 OCT 2017

SIGNATURE

//SIGNED// Hardaway, Christopher J

USER TYPE

Engineer

SIGNATURE DATE

30 OCT 2017

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