| Other Than New Material WorksheetPage | Last Updated: February 10, 2012 |
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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 No.: _____________________________________________________ NSN: _____________________________________________________________ Noun: ____________________________________________________________ P/N: ______________________________________________________________ Drawing No./Revision: ___________________________________________ 2. SUBMISSION. The submitter shall provide supporting documentation as necessary to demonstrate that the OTHER THAN NEW material offered meets solicitation requirements. Used, reconditioned, or remanufactured items shall not be used unless the Contracting Officer has authorized their use. In order for the Contracting Officer to make that determination, the submitter shall provide certain information along with supporting documentation on or before the date that the quote/offer is due, or within the timeframe specified by the Contracting Officer if additional documentation is requested after submission of the quote/offer. 3. ACQUIRED FROM. Items were acquired as OTHER THAN NEW from one of the following sources: GOVERNMENT SOURCE Government (Selling) Agency: _______________________________________ Address:________________________________________________________ _______________________________________________________________ Government Contract Number: _________________________________________ Government Contract Date: ____________________________________________ Date Acquired: _____________________________________________________ OTHER THAN A GOVERNMENT SOURCE Source Obtained From: _______________________________________________ Source Address: ____________________________________________________ _________________________________________________________________ Date Acquired From Source:__________________________________________ Government Contract Number: _______________________________________ Government Contract Date: __________________________________________ 4. DESCRIPTION: Check as appropriate and provide information and supporting documentation. For information concerning definitions, please see Federal Acquisition Regulation (FAR) 52.211-5, Material Requirements. ( ) RECONDITIONED a. Source of Reconditioning: include name of company, address, and phone number. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ b. Summary of Reconditioning (provide full details): _______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ( ) RECOVERED MATERIAL: a. Source of Material: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ b. Summary of Material: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ ( ) REMANUFACTURED: a. Source of Remanufacture: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ b. Summary of Remanufacture: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ( ) RESIDUAL INVENTORY: a. Source: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ b. Summary/pertinent information: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ( ) UNUSED FORMER GOVERNMENT SURPLUS: a. Source of surplus material: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ b. Summary/pertinent information: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 5. ADDITIONAL INFORMATION REQUIRED FOR ALL SUBMISSIONS: SHELF LIFE. Items being offered to the government that have any associated parts with a shelf life must be identified. Please list those items along with whether or not they have been replaced with new parts. Item: _____________________________________________________________ Shelf Life: ________________________________________________________ Replacement Date: ______________________________________________
Item: _____________________________________________________________ Shelf Life: ________________________________________________________ Replacement Date: _______________________________________________
Item: _____________________________________________________________ Shelf Life: ________________________________________________________ Replacement Date: _______________________________________________ PACKAGING. ( ) The offered material is in its original package. Describe packaging: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ( ) The offered material is not in its original packaging. Describe packaging: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Unless the solicitation states otherwise, submitters of other than new material are authorized to open packages, inspect material, and reseal packages. Each time this is done, the submitter's authorized representative or inspector must sign the packages where they were resealed and annotate the date of inspection. STORAGE - Items were stored: 1. Outside. State how stored/protected: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2. Inside. State how stored/protected: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 6. 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: _______________
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