AFMC 813.pdf

SURPLUS MATERIEL WORKSHEET

DATE

12 JUL 2024

I. REQUEST FOR EVALUATION

NSN

1560009667522GA

PART NUMBER

205-001-905-1

CAGE

97499

APPLICATION

JEDMICS

IMS

Corbett, Felton C

OFFICE SYMBOL

AFLCMC / WIUED

PHONE

478-926-6171

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

N

N

N

Y X X X X

N

N

N

G O V T

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

C O M M L

S U R P L U S

NEW/UNUSED

NEW/RECONDITIONED

NEW/MODIFIED

USED/OVERHAULED

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

PART NUMBER VERIFICATION 97499(AFMCFARS 5352.211-9011) MFG 205-001-905-1P/N

PRIOR GOVERNMENT OWNERSHIP (AFMCFARS 5352.211-9015)

100% END ITEM INSPECTION (AFMCFARS 5352.211-9017)

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

VERIFIABLE DIMENSION (AFMCFARS 5352.211-9012) DESIGN ACTIVITY JEDMICS

DRAWING NUMBER 205-001-905-1

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

This is a Critical Safety Item (CSI) part. Failure of this part in flight will result in loss of control of the aircraft that can result in the loss of aircraft and crew. The parts being procured must match exactly with the requirements, dimensions, material specification shown on Bell drawing number 205-001-905, Revision L or later. This part shall conform to all Bell specifications shown on the drawing.

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

OVERHAUL AND CERTIFICATION (AFMCFARS 5352.211-9010)

This part shall be in new condition with no damage to the coatings or finishes. There shall be no marks, scratches, dents/dings, missing parts, or visible corrosion. The part numbers and markings shall be clearly legible. These parts shall be in the original unopened packaging. Documentation shall be provided to show traceability to the OEM Bell Helicopter CAGE 97499.

OTHER SPECIAL REQUIREMENTS (Explain)

Corbett, Felton CNAME: 12 JUL 2024DATE:

This part shall be in new condition with no damage to the coatings or finishes. There shall be no marks, scratches, dents/dings, missing parts, or visible corrosion. The part numbers and markings shall be clearly legible. These parts shall be in the original unopened packaging. Documentation shall be provided to show traceability to the OEM Bell Helicopter CAGE 97499.

REMARKS

JUSTIFICATION FOR UNACCEPTABLE SURPLUS MATERIEL

Any surplus part with visible damage to include (but not limited to) corrosion, scratches, dents/dings, illegible markings, or missing parts shall not be procured. Any part missing documentation shall not be procured. Any part showing signs that it has been installed on aircraft (for example, scratches inside of bearings or bushings) shall not be procured.

EVALUATOR

Corbett, Felton C

OFFICE SYMBOL

AFLCMC / WIUED

PHONE

478-926-6171 / 468-6171

COMPLETE DATE

12 JUL 2024

Page 1 of 2AFMC FORM 813, 20000323 (IMT-V1) Version 2Generated by PRPS using Jasper Reports on 19 Jul 2024

SURPLUS MATERIEL WORKSHEET

DATE

12 JUL 2024

SIGNATURE

//SIGNED// Corbett, Felton C

USER TYPE

Engineer

SIGNATURE DATE

12 JUL 2024

Page 2 of 2AFMC FORM 813, 20000323 (IMT-V1) Version 2Generated by PRPS using Jasper Reports on 19 Jul 2024