FAT_Worksheet_EH8E1797EH.pdf

FIRST ARTICLE WAIVER WORKSHEET*

(Request for information and supporting documentation)

This information/supporting documentation is part of your quote/offer. It must be submitted on Company letterhead and signed by an agent of the Company. Contact the buyer, if you have any questions about the acquisition offer/quote requirements.

1. CURRENT ACQUISITION INFORMATION:

Buyer’s name: _________________________________________________ Solicitation/Contractor No.: _____________________________________________

NSN: ___________________________________________________________

NOUN: __________________________________________________________

P/N: ____________________________________________________________ Drawing No./Revision Level: __________________________________________

2. TYPE OF REQUEST:

______ Partial Waiver - Includes waiver of only specific test(s) of the First Article Test requirement as required by the TDPL and/or solicitation.

______ Full Waiver - Includes waiver of all First Article Testing as required by the TDPL and/or solicitation.

● TDPL Reference(s) of test(s) to be waived: (Please be specific and reference specification paragraph and /or Drawing note as appropriate):

3. JUSTIFICATION TO SUPPORT WAIVER REQUEST: (check and complete all that apply)

a. _____ Successful completion of a First Article Test on a recent contract for the same item(s). Complete the following and attach supporting documentation*:

● Contract number and date of the First Article Test:

● Was the above contract manufactured at the same facilities in which the current item is being procured? Yes_______ No _______ If no, please explain:

b. ______ Successful completion of a First Article Tests on a similar item on a recent contract and the item has been tested on the same or substantially similar specification(s) as those herein referenced. Complete the following for the similar item and attach supporting documentation*:

Contract number ___________________________________________________ Nomenclature ______________________________________________________ Part Number ________________________________________________________

NSN ________________________________________________________________

Date of First Article Test ____________________________________________

Briefly describe the major differences between the similar item and the item being procured:

● Was the similar item manufactured at the same facilities in which the current item is being procured? Yes_______ No _______ If no, please explain:

c. ______ Material has been in continuous production. Provide length of production run and date of last successful First Article Test. Attach supporting documentation*:

d. ______ Recent and successful performance of a first article test on the next higher assembly. A waiver may be requested in order to eliminate duplication of testing on the lower assembly. Complete the following for the next higher assembly and attach supporting documentation*:

Date of First Article Test ________________________________________ Nomenclature __________________________________________________ Part Number ___________________________________________________

NSN ___________________________________________________________

Contract number _______________________________________________ Provide a full explanation justifying why duplicate testing is unnecessary:

● Was the next higher assembly manufactured at the same facilities in which the current item is being procured? Yes_______ No _______ If no, please explain:

e.________ Other - A waiver or partial waiver of the FAT is being requested based on the following: (Please be specific and attach supporting documentation as appropriate):

4. Other Pertinent Information:

a. ______ There are quality issues which affect the fit, form, or function of the item being procured, which may not be known by the Government. Please briefly discuss below:

b. _______ There have been changes made to the item, processes or subcontractors used to manufacture the item, which may not be known by the Government. Please describe below:

5. SUBMISSION:

The submitter, by signing the below, certifies that the above statements are true and correct. Please provide printed name, signature, company address, and phone number where you can be reached. Again, the signer must be an agent of the company.

Signature: ____________________________________________________________

Printed Name: ________________________________________________________

Title: _________________________________________________________________

Company Name: ______________________________________________________

Company Address:

Phone Number: ___________________ Cage Code: ___________________

* See the solicitation/contract for information on submitting supporting documentation as well as additional requirements regarding First Article Test Waiver Requests.