Surplus Material Form.pdf

SURPLUS MATERIAL EVALUATION FORM, v1.2 PREVIOUS EDITION IS OBSOLETE

REQUIRED INFORMATION FOR SURPLUS MATERIAL EVALUATION

Submission of the following information for each item of surplus material included in the offeror's proposal is required to comply with the terms and conditions of FAR 11.302 (b). Information must be adequate to provide the basis for determinations required by the policy contained in FAR 11.302 (b).

A. ITEM INFORMATION

Surplus Item Identification NSN Noun Part Number Drawing Rev: & Manufacturer:

B. SURPLUS INFORMATION

Federal Supply Code for Manufacturer (FSCM) (marked on items per MIL-STD-130) _________________ Quantity available for verification at dealer's facility: ___________

Original manufacturer, government contract number:

Material was subsequently purchased as surplus from (Manufacturer or Agency):

DLA sale number _____________________ Date of sale by Government _________________

Do you have the drawings for this item? NO YES

If yes, Revision letter/number _________________ Date of Last Revision

History of items since initially sold as surplus by Government or manufacturer: _______________________________________________________ (Storage Location, Packaging, Rework, Reconditioning, Repair, etc.)

Are items being offered in original unbroken containers? ____________ Date of manufacture or packaging: _______________

C. WARRANTY INFORMATION

Material offered is warranted by the Contractor for a period of ____ months as contemplated by FAR 52.246-17, Warranty of Supplies of a Noncomplex Nature.

(12 Months is presumed unless otherwise specified. If surplus is purchased, warranty may or may not be included in the award.)

D. CONDITION OF SURPLUS

The surplus items offered fit the conditional definition indicated below:

(Check the appropriate definition and provide requested information. Use additional paper if more space is necessary.)

(NOTE: Dates, Technical Order compliance, quality considerations, and component sources are essential information for categories (2), (3), and (4) b l ) _______(1) New and unused: material has never been installed or used. It shows no signs of rust, corrosion, or other deterioration due to age or improper packaging/preservation. It has not been reconditioned and shows no evidence of disassembly or reassembly.

______ (2) New and reconditioned: material has never been installed or used. It shows no signs of rust, corrosion, or other deterioration due to age or improper packaging/preservation. Reconditioning is allowed to the extent that gaskets, seals, O-rings, or other such cure-dated items have been or will be replaced prior to use in accordance with the applicable technical orders and specifications.

Source of reconditioning: Summary of reconditioning:

_____ (3) New and modified: material has never been installed or used. It shows no signs of rust, corrosion, or other deterioration due to age or improper packaging/preservation. Components may have been (or may need to be) replaced in accordance with the applicable technical specifications for the purpose of configuration update or modification.

Source of modification: Summary of modification:

_____ (4) Used and overhauled: material which has been previously installed in operational equipment. It has been or can be completely overhauled, repaired, reconditioned, or modified per the applicable technical specifications to serviceable status.

Source of overhaul: Overhaul technical order:

SOURCE OF SURPLUS (X one) ATTACHMENTS REQUIRED Company Name: Cage:

SOS Releasing Officials NAME (Last, First, Middle Initial)

Signature Date Signed

1. A copy of the label from the original packing

2. Request for Quote Form