Surplus_Materiel_Worksheet.pdf

SURPLUS MATERIEL WORKSHEET

DATE

08 AUG 2013

I. REQUEST FOR EVALUATION

NSN

4710013185083NZ

PART NUMBER

4076853-01

CAGE

77445

APPLICATION

F100-229 Aircraft Engine

IMS

Williamson, Craig A

OFFICE SYMBOL

AFLCMC / LPSAAB

PHONE

405-734-8775

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

N

N

N

N

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 77445(AFMCFARS 5352.211-9011) MFG 4076853-01P/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

DRAWING NUMBER

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

Criteria for the "100% End Item Inspection" shall be determined by the Cognizant Engineering Authority (CEA) during review of the completed "Required Information for Surplus Material Evaluation" form.

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

OVERHAUL AND CERTIFICATION (AFMCFARS 5352.211-9010)

Surplus Offerors shall complete and return the "Required Information for Surplus Material Evaluation" form, attached, in accordance with FAR 11.302(b). An alternate method of providing all of the information requested on the "Required Information for Surplus Material Evaluation" form, including the required attachments, is acceptable.

The Contracting Officer shall obtain approval/disapproval from the Cognizant Engineer based on the completed form returned by the surplus offeror prior to accepting or rejecting the surplus offer.

OTHER SPECIAL REQUIREMENTS (Explain)

Billingsley, Sarah BNAME: 15 AUG 2013DATE:

This is a Critical Safety Item (CSI) for the F100-229 engine.

REMARKS

JUSTIFICATION FOR UNACCEPTABLE SURPLUS MATERIEL

- The parts provided must be made to the current revision letter of the drawing 4046903 or have special approval by the CEA.

- Misrepresentation of an item by the surplus vendor will be cause for rejection.

- Damage to packaging will be cause for additional inspection for corrosion.

- Any evidence of corrosion will be cause for rejection.

- Rejected parts will be will be returned to the vendor at no cost to the government.

EVALUATOR

Billingsley, Sarah B

OFFICE SYMBOL

OC-ALC / GKGAAB

PHONE

405-734-8715 / 884-8715

COMPLETE DATE

15 AUG 2013

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SURPLUS MATERIEL WORKSHEET

DATE

08 AUG 2013

SIGNATURE

//SIGNED// Billingsley, Sarah B

USER TYPE

Engineer Workload Manager

SIGNATURE DATE

15 AUG 2013

Page 2 of 2AFMC FORM 813, 20000323 (IMT-V1) Version 7Generated by PRPS using Jasper Reports on 20 Nov 2020