SPRWA1220020 ATTACHMENTS 1-6.pdf
PDF 275 KB Posted
- Attached to
- ALR-56M IF Assembly Federal contract opportunity
- Solicitation number
- SPRWA1-22-R-0020
- Issued by
- Defense Logistics Agency Aviation
About this file
This is a solicitation for an indefinite delivery, indefinite quantity contract to acquire components for the ALR-56M Intermediate Frequency Assembly from General Microwave. The Defense Logistics Agency will issue the sole source solicitation to procure units of NSN 5996-01-685-3623EW over a five year period, with pricing periods in years one through five and delivery within 12 months of award. General Microwave is the manufacturer under CAGE 11332. Responses are due by August 1, 2022 and award will be made only if the offeror, product, or manufacturer meets qualification requirements at that time in accordance with FAR 52.209-1 or 52.209-2.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| SPRWA122R0020 RFP.pdf | ||
| Attachment_07_Pricing_Matrix.xlsx | XLSX spreadsheet |
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Text version
DD FORM 1423-1, FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
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 the Department of Defense, Executive Services and Communications 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
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
A X
ALR-56M FD2060-22-00137 GMI
A001 Test Procedure Acceptance Test Procedure (ATP)
DI-NDTI-80603A 408 SCMS/GULB
WAWF
A D
AS REQ
See Blk 16
See Blk 16
See Blk 16
408 SCMS/GULB 0 1 0
0 1 0
Blk 4: Contractor format is acceptable. Acceptance Test Procedure shall be type written in Microsoft Word with support files in Microsoft Excel and Microsoft Project. Acceptance Test Procedure shall be formatted for printing on standard 8.5" x 11" paper. Acceptance Test Procedures shall have developed in accordance with 330404 drawings specifications. Submissions shall be electronically submitted
BLK 7: Submit invoice in WAWF (FB2065) after submittal of final report to account for all previously submitted.
BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only due to operational use as of June 26th, 2021. Other requests shall be referred to AFLCMC/WIG or higher DoD authority.
BLKS 11 & 12: First submission shall be no later than 90 days after contract award. Approval/Disapproval of subsequent submissions will be furnished within 30 days of receipt.
BLK 13: Revisions shall be furnished to personnel mentioned above within 30 days after receipt of comments.
BLK 14: Submissions shall be made electronically to the Contracting Officer, Program Manager, and Program Engineer. Contractor shall request point of contact names and email addresses prior to submission.
Jared Pitts 8 April 2021 3 Nov 21
GORDON.JAMES.H.JR
.1233601710
Digitally signed by
GORDON.JAMES.H.JR.1233601710
Date: 2021.11.03 12:14:17 -04'00'
(1 Data Item)
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
16. REMARKS (Continued)
DD FORM 1423-1, FEB 2001 Page of Pages
A X
ALR-56M FD2060-22-00137 GMI
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package;
TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15.
Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.
DD FORM 1423-1 (BACK), FEB 2001
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
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 the Department of Defense, Executive Services and Communications 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
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
A X
ALR-56M FD2060-22-00137 GMI
A002 Test/Inspection Report Acceptance Test Report (ATR)
DI-NDTI-80603A 408 SCMS/GULB
WAWF
A D
AS REQ
See Blk 16
See Blk 16
See Blk 16
408 SCMS/GULB 0 2 0
0 2 0
Blk 4: Contractor format is acceptable. Acceptance Test Report shall be type written in Microsoft Word with support files in Microsoft Excel and Microsoft Project. Acceptance Test Report shall be formatted for printing on standard 8.5" x 11" paper. Acceptance Test Report shall document testing of units in accordance with Government approved ATP/Specifications. Report shall only indicate pass/fail associated with specification paragraph due to sensitive nature of the specifications. First submission shall be delivered electronically via e-mail
BLK 7: Submit invoice in WAWF (FB2065) after submittal of final report to account for all previously submitted.
BLK 8: Approval/Disapproval of first submission will be furnished within 45 days.
Approval/Disapproval of subsequent submissions will be furnished within 30 days of receipt.
BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only due to operational use as of June 26th, 2021. Other requests shall be referred to AFLCMC/WIG or higher DoD authority.
BLKS 11, 12, & 13: Submissions shall be no later than 30 days after acceptance testing (Group A) has completed.
BLK 14: Submissions shall be made electronically to the Contracting Officer, Program Manager, and Program Engineer. Contractor shall request point of contact names and email addresses prior to submission.
Jared Pitts 8 April 2021 3 Nov 21
GORDON.JAMES.H
.JR.1233601710
Digitally signed by
Date: 2021.11.03 12:20:42 -04'00'
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
16. REMARKS (Continued)
DD FORM 1423-1, FEB 2001 Page of Pages
A X
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package;
TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15.
Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
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 the Department of Defense, Executive Services and Communications 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
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
A X
ALR-56M FD2060-22-00137 GMI
A003 Item Unique Identification (IUID) Marking Plan Item Unique Identification (IUID) Marking Plan
DI-MGMT-81803 408 SCMS/GULB
WAWF
A D
See Block 16
See Blk 16
See Blk 16
See Blk 16
408 SCMS/GULB 0 2 0
0 2 0
BLK 4: Contractor format is acceptable. IUID Marking Plan shall be type written in Microsoft Word with support files in Microsoft Excel and Microsoft Project.
IUID Marking Plan shall be formatted for printing on standard 8.5" x 11" paper.
Submission shall be delivered electronically via email to the following people:
Marking Plan shall be delivered electronically via E-mail
BLK 7: Submit invoice in WAWF (FB2065) after submittal of final report to account for all previously submitted.
BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only due to operational use as of June 26th, 2021. Other requests shall be referred to AFLCMC/WIG or higher DoD authority.
BLKS 8 & 10-13 Submit NLT 30 days after contract award. Government comments/approval will be provided 15 days after receipt. The contractor shall submit within 15 days after receipt of Government comments.
BLK 14: Submissions shall be made electronically to the Contracting Officer, Program Manager, and Program Engineer. Contractor shall request point of contact names and email addresses prior to submission.
Jared Pitts 8 April 2021
GORDON.JAMES.H.JR.
1233601710
Digitally signed by
Date: 2021.11.03 12:19:11 -04'00'
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
16. REMARKS (Continued)
DD FORM 1423-1, FEB 2001 Page of Pages
A X
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package;
TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15.
Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
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 the Department of Defense, Executive Services and Communications 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
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
A X
ALR-56M FD2060-22-00137 GMI
A004 Item Unique Identification (IUID) Marking Activity and Verification Report
Item Unique Identification (IUID) Marking Activity and
DI-MGMT-81804A 408 SCMS/GULB
WAWF
A D
ASREQ
See Blk 16
See BLK 16
See BLK 16
408 SCMS/GULB 0 2 0
0 2 0
BLK 4: Contractor format is acceptable. 100% of the units shall be inspected, evaluated and added to the Activity and Verification Report.
Initial report during each production cycle with be delivered electronically via E-mail
All subsequent reports will be stored for 3 years within the contractor's facility or until deemed no longer required by AFLCMC/WIG
BLKS 8 & 10-13 Delivery shall be 30 days after Government acceptance of each asset. Government comments/approval will be provided 15 days after receipt. The contractor shall submit within 15 days after receipt of Government comments.
BLK 7: Submit invoice in WAWF (FB2065) after submittal of final report to account for all previously submitted.
BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only due to operational use as of June 26th, 2021. Other requests shall be referred to AFLCMC/WIG or higher DoD authority.
BLK 14: Submissions shall be made electronically to the Contracting Officer, Program Manager, and Program Engineer. Contractor shall request point of contact names and email addresses prior to submission.
Jared Pitts 8 April 2021 3 Nov 21
GORDON.JAMES.H.J
R.1233601710
Digitally signed by
Date: 2021.11.03 12:17:54 -04'00'
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
16. REMARKS (Continued)
DD FORM 1423-1, FEB 2001 Page of Pages
A X
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package;
TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15.
Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
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 the Department of Defense, Executive Services and Communications 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
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
A X
ALR-56M FD2060-22-00137 GMI
A005 Counterfeit Prevention Plan Counterfeit Prevention Plan Verification Report
DI-MISC-81832 408 SCMS/GULB
WAWF
A D
ONE/R
ASREQ
30DAC
ASREQ
408 SCMS/GULB 0 2 0
0 2 0
BLK 4: Contractor format is acceptable. Counterfeit Prevention Plan shall be type written in Microsoft Word with support files in Microsoft Excel and Microsoft Project. Counterfeit Prevention Plan shall be formatted for printing on standard 8.5" x 11" paper. Submission shall be delivered electronically via email
BLK 7: Submit invoice in WAWF (FB2065) after submittal of final report to account for all previously submitted.
BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only due to operational use as of June 26th, 2021. Other requests shall be referred to AFLCMC/WIG or higher DoD authority.
BLK 14: Submissions shall be made electronically to the Contracting Officer, Program Manager, and Program Engineer. Contractor shall request point of contact names and email addresses prior to submission.
Jared Pitts 8 April 2021 3 Nov 21GORDON.JAMES.H.J R.1233601710
Digitally signed by
Date: 2021.11.03 12:15:43 -04'00'
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
16. REMARKS (Continued)
DD FORM 1423-1, FEB 2001 Page of Pages
A X
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package;
TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15.
Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data
TRANSPORTATION DATA FOR SOLICITATIONS
COMMODITY: See Continuation
PURCHASE INSTRUMENT NUMBER:
FD20602200137-00
DATE INITIATED:
17 MAR 2022
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
TACRN:
AAA
TRANSPORTATION FUNDS INFORMATION:
Purchase Instrument Line LOA: 97X4930.FC04 642 47GR 15672M 01N000 00000 000000 503000 F03000 FSR: 013408 PSR: K29022
First Destination Transportation Account Code: FRS6
Miscellaneous Obligation / Reimbursement Document:
Second Destination Transportation Account Code:
FMS LOA:
Additional Funding Information:
ITEM / SHIP TO(s):
NSN / Pseudo NSN: 5996016853623EW
Purchase Instrument Line Item Number: 0001
Ship to (DoDAAC / MAPAC): SW3119
Mark For:
Ship To (Address): DLA DISTRIBUTION WARNER ROBINS
BLDG 376
ROBINS AFB, GA
31098 - 1887
USA
WPOD:
APOD:
BBP / CCP:
RIC:
Requisition Number:
Supplemental Address:
FMS Case:
455 BYRON STREET
Ship To (Remarks):
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NSN / Pseudo NSN: 5996DTL22012DEW
Purchase Instrument Line Item Number: 0002
Ship to (DoDAAC / MAPAC): SW3119
Mark For:
Ship To (Address): DLA DISTRIBUTION WARNER ROBINS
BLDG 376
ROBINS AFB, GA
31098 - 1887
USA
WPOD:
APOD:
BBP / CCP:
RIC:
Requisition Number:
Supplemental Address:
FMS Case:
455 BYRON STREET
Ship To (Remarks):
EVALUATION OF PORT BID OR PROPOSAL:
SOLICITATION DATA NOTES:
OTHER TRANSPORTATION DATA:
NAME
Pate, Robert T
ORGANIZATION / OFFICE
SYMBOL
406 SCMS / GULAA
COMMERCIAL / DSN
PHONE
478-926-2771 / 468-2771
SIGNATURE
//SIGNED//Pate, Robert T
DATE
17 MAR 2022
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PACKAGING REQUIREMENTS
PURCHASE INSTRUMENT NUMBER: FD20602200137-00 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:
AAA MIL-STD-2073-1 / No Packaging Available MIL B
ITEM(S):
5996016853623EW
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.
Page 1 of 2AFMC 158 Version 1Generated by PRPS using Jasper Reports on 22 Mar 2022
PACKAGING REQUIREMENTS
PACRN: PACKAGING REQUIREMENT: PRESERVATION LEVEL: PACKAGING LEVEL: SPI: SPI REV: SPI DATE:
AAB No Packaging Data Required
ITEM(S):
5996DTL22012DEW
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:
ORGANIZATION / OFFICE SYMBOL:
406 SCMS / GULAA
PACKAGING SPECIALIST:
Martinez, Lorenda L
PHONE NUMBER:
478-327-6313 / 497-6313
SIGNATURE:
//SIGNED//Martinez, Lorenda L
DATE:
22076 - 17 MAR 2022
Page 2 of 2AFMC 158 Version 1Generated by PRPS using Jasper Reports on 22 Mar 2022
ITEM UNIQUE IDENTIFICATION (IUID) CHECKLIST
I. IUID DETAILS: DFARS 252.211.7003
SECTION (c) (1) (i) APPLIES TO THE FOLLOWING:
ITEM REQUIRING IUID MARKING
NSN
5996016853623EW
VERSION NUMBER
NOUN
AMPLIFIER,INTERMEDI
INITIATOR
Truong, Kevin
ORGANIZATION CODE / OFFICE SYMBOL
408 SCMS / GUEA
COMMERCIAL PHONE
478-222-8342
DSN PHONE
472-8342
CAGE / REFERENCE NUMBER
2198A / 2773 81413 / 330386-501
MARKING IS TO BE PERFORMED IN ACCORDANCE WITH THE LATEST VERSION OF MIL-STD-130
MARKING GUIDANCE
Engineering Drawing / ECP / ECO
ENGINEERING DRAWING / ECP / ECO NUMBER
MARKING TYPE MARKING METHOD
DESCRIPTION / LOCATION
REMARKS
ATTACHMENT(S)
II. EMBEDDED ITEMS
SECTION (c) (1) (iii) APPLIES TO THE FOLLOWING:
NSN NOUN
CAGE / REFERENCE NUMBER
ITEM IS AN EMBEDDED ITEM FOR NSN / PSEUDO NSN: 5996016853623EW
MARKING GUIDANCE ENGINEERING DRAWING / ECP / ECO NUMBER
MARKING TYPE MARKING METHOD
DESCRIPTION / LOCATION
REMARKS
ATTACHMENT(S)
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RECOMMENDED QUALITY ASSURANCE PROVISIONS
AND SPECIAL INSPECTION REQUIREMENTS
1. PR / MIPR NUMBER
2. NATIONAL STOCK NUMBER
5996016853623EW
3. POINT OF INSPECTION
SOURCE DESTINATION
X
SEE DFARS 246.402
4. POINT OF ACCEPTANCE
SOURCE DESTINATION
X
5. ITEM MANAGER / PHONE
Goff, Tanner J / 478-222-4561
6. EQUIPMENT SPEC / PHONE
Burkes, Michelle A / 478-222-4677
7. CONTRACT QUALITY REQUIREMENTS/SPECIAL INSPECTION REQUIREMENTS
CERTIFICATE OF CONFORMANCE
FAR 52.246-15
CONTRACT RESPONSIBILITY
FOR INSPECTION
FAR 52.246-1
STANDARD INSPECTION
FAR 52.246-2,-3,-4,-5 OR -6
AS APPLICABLE TO CONTRACT
X HIGHER LEVEL CONTRACT QUALITY REQUIREMENTS
ISO 9001:2000
COMMERCIAL ITEM INSPECTION
FAR 52.212-4
OTHER (Describe in Block 8)
8. REMARKS
8a. OZONE DEPLETING SUBSTANCES (ODS)
X STATEMENT
"I HAVE REVIEWED THE REQUIREMENT, INCLUDING AVAILABLE TECHNICAL DOCUMENTATION, AND BELIEVE THAT IT DOES NOT REQUIRE THE CONTRACTOR USE CLASS I OZONE DEPLETING SUBSTANCES (ODS) IDENTIFIED IN AIR FORCE POLICY, NOR IS IT WRITTEN SO THAT IT CAN
ONLY BE MET BY THE USE OF A CLASS I ODS."
WAIVER (SEE AF FARS 5323)
NOTE: Quality provisions as annotated hereon will not be downgraded without Technical Authority coordination. The Technical Authority must be notified if award selection is made to a new source using Acquisition Method Code (AMC) 3, 4, or 5.
9. QUALITY PRE-AWARD SURVEY
YES NEW SOURCE
X PREVIOUS SOURCEX NO
AFMC PARTICIPATION
RECOMMENDED
10. CODES
A. I&A
B. CQR
G
11. SIGNATURE OF TECHNICAL AUTHORITY
Truong, Kevin
ORGANIZATION / SYMBOL
408 SCMS / GUEA
PHONE
478-222-8342 / 472-8342
DATE
19 OCT 2021
Page 1 of 1AFMC FORM 807, 20060111, V1 Version 1Generated by PRPS using Jasper Reports on 22 Mar 2022
ITEM DESCRIPTION
NSN
5996016853623EW
CAGE
81413
REFERENCE NUMBER
330386-501
NOUN
AMPLIFIER,INTERMEDI
END ITEM TCTO NUMBER TO NUMBER
12P3-2ALR56M-34
CRITICALITY CODE
X
DEMILITARIZATION CODE
D
SECURITY CODE
MDC
B1D
ES CODE
3K
REMARKS
INITIATOR
NAME
MICH…
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