Technical_Data_Request_Questionairre_12.6.2016.pdf

AMSTA-AR Form 1350, January 2011 ARDEC V 1.0

Technical Data Request Questionnaire

This Questionnaire is designed to provide Government personnel with a detailed description of the technical data being requested as well as adequate information to permit compliance with Department of

Defense (DoD) Directives 5230.24 and 5230.25. Each question should be answered completely and in detail, thereby providing the Government with all the information necessary to satisfy the request for technical data promptly. Failure to provide a complete response to all questions and/or abstract answers, such as “unknown”, “not available”, etc. may unnecessarily delay the processing of your request and/or result in denial of release.

1. Name of Requester: ____Derek Jones___________________________________

Address: _900 Bob Ehlen Dr. ___________________________________

_Anoka, Minnesota 55303______________________________

Point of contact regarding this request: Derek Jones

Telephone Number (including area code): 763-323-2544

2. U.S./Canada Joint Certification Office Certification Number: 0075588

(Assigned after submittal and approval of DD Form 2345, Militarily Critical Technical Data Agreement)

3. Requester’s proof of legitimate business interest in the information requested. Examples of such are submission of Federal Supply Code (FSC) or Contractor and Government Entity Cage Code

(CAGE): 73JN6

4. Is Requester a citizen of the United States? Yes X No ______

If “No”, specify citizenship: ______________________________________________________

5. Identify the solicitation and technical data number (i.e. Technical Data Package Number, Drawing Number or Specification Number) under which this technical data is being requested:

W15QKN: -17-R-0022

Technical Data Number:

PRF16001A0006 Cartridge, 5.56 Millimeter, Frangible MK 311 Mod 3 Dated 16 November 2016

16001A0006 Cartridge, Caliber 5.56mm, Frangible MK311 Mod 3

TOP 1-2-608 Sound Level Measurements

TOP 2-2-614 Toxic Hazards Test for Vehicles and Other Equipment

TOP 3-2-045 Automatic Weapons, Machine Guns, Hand and Shoulder Weapons

AMSTA-AR Form 1350, January 2011 ARDEC V 1.0

TOP 3-2-609 Chemical Compatibility of Nonmetallic Materials Used in Small Arms Systems

NAVSEAINST 8020.19 Electrostatic Discharge Safety Program For Ordnance Qualification

VANSEAINST 8020.5 Final (Type) Qualification for Navy Explosives

TB 700-2 Department of Defense Ammunition and Explosives Hazard Classification Procedures

DMWR 9-1300-0017-D1 Depot Maintenance Work Requirements for Demilitarization of

Miscellaneous Small Arms Ammunition

6. Any technical data which may be released will be subject to the terms and conditions as given in the solicitation and the following:

a. Should the United States Government inadvertently deliver to the Requester any documents containing restrictive legends (prohibiting use by the Requester), the

Requester agrees to promptly return such documents without using, copying or disclosing same to third parties.

b. If the said data is governed by the Arms Export Control Act and the International

Traffic in Arms Regulations (ITAR), registration with the Department of State, Directorate of Defense Trade Controls, is required prior to manufacture or export of the defense article or furnishing of the defense service made in accordance therewith, unless an exemption under the ITAR applies.

c. If the said data is governed by the Arms Export Control Act and the International

Traffic in Arms Regulations (ITAR), an export license must be obtained from the

Department of State, Directorate of Defense Trade Controls, before the said data, or any portion thereof, or any items made in accordance therewith, are exported, unless an exemption under the ITAR applies.

I certify that all statements made by me are true and correct to the best of my belief and I agree to all terms and conditions of the release.

Signed on behalf of: ___Vista Outdoor Sales LLC __________________________________________________________

(Name of Firm)

On: _02 December 2016 ________________________________________________________________________

(Day, Month, Year)

By: ___Derek Jones, Contracts Specialist _____________________________________________________

(Typed or Printed Name and Title)