COMPANY INFORMATION
Company Name
Address Line 1
Address Line 2
City
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Country
United States Canada Other
Contact Name
Title
Phone
Fax
Facility Area (Sq. Ft.)
Number of Employees
Email Address

Indicate if Your Business is:
Manufacturer
Distributor
FAA Repair
Other:
Please List the Types of Products or Services You Supply:

QUALITY SYSTEM
The Quality System is Derived from a Quality Assurance Specification as Follows:
Mil-Q-9858
Mil-I-45208
FAR 21
FAR 145
ISO 9001:2000
AS 7204 NADCAP
AS 9100
AC 00-56
FAA issued 'Repair Staion Operations Specs" Incl A449 Form
EASA Certificate
Transport Canada MRO Certificate
Case 1A Standard
Other
None

US GOVERNMENT
Cage Code:
NAICS Code (s):
Percent of sales to the US Government:

Government Quality Representative (QAR):
Itinerant
Resident
None
Name
Phone Number

Has your company ever been debarred from U.S. Government procurement?
Yes
No
If yes, Please explain:

DOES YOUR COMPANIES CERTIFICATE OF CONFORMANCE (CoC) WITH EACH SHIPMENT CONTAIN THE FOLLOWING?
Part Number?
Yes
No
N/A
Condition of Part?
Yes
No
N/A

TKCA Purchase Order Number
Yes
No
N/A
Authorized Signature?
Yes
No
N/A
Revision Level?
Yes
No
N/A
Name of Manufacturer?
Yes
No
N/A
Lot/Batch Numbers?
Yes
No
N/A
Cure Date?
Yes
No
N/A
Shelf Life Data?
Yes
No
N/A

PLEASE ANSWER THE FOLLOWING QUESTIONS:
Do you provide life limited materials shipped with a minimum of 75% life remaining?
Yes
No
N/A
Do you provide pull test data for cables?
Yes
No
N/A
Do you provide pressure test data for hoses?
Yes
No
N/A
Do procedures define the facilities and environments for calibration, handling, control, storage and maintenance of all measureing and test equipment?
Yes
No
N/A
Are calibration standards traceable to NIST?
Yes
No
N/A
Are Material Safety Data Sheets (MSDS) supplied with hazardous volatile or toxic materials?
Yes
No
N/A
Does this repair station meet the Antidrug and Alcohol Misuse Prevention Program to which each employee who performs a safety-sensitive function, directly or by contract, including by sub-contract at any tier, is in compliance with the amended Anti-drug and Alcohol Misuse Prevention program requirements described in 14CFR part 121, appendix 1, section II and appendix J, section 1R
Yes
No
N/A
Do Overhauled components include airworthy or FAA 8130-2 tags with work order/tear down reports?
Yes
No
N/A
Do repairable and surplus components have certification that the parts have not been involoved in an incident or accident which would render them un-airworthy?
Yes
No
N/A
Has lot/batch segregation been maintained?
Yes
No
N/A
Do you have recall capabilities for non-conforming products?
Yes
No
N/A
Does the system acknowledge the right of a company representative to verify at source that the purchased product conforms to contract requirements?
Yes
No
N/A
How many years are Records of Traceability kept and how will they be made available?
Number of years records are kept:
Will be Provided
Available on Request
N/A

PRODUCT LIABILITY
Does your company maintain product liabillity insurance that covers the products you sell, and for the work and services you perform in an amount not less than Five Million US dollars ($5,000,000 USD)? (Proof will be required)
Yes
No
N/A

QUALITY ORGANIZATION SYSTEM
Title of Head of Quality Assurance:
Title of person to whom they report:
Number of inspection personnel:
Ratio of inspection to production personnel:
Have your facilities previously been surveyed by TKC Aerospace, Inc?
Yes
No
Briefly descibe the following:
Production Equipment:
Inspection Equipment:
Functional Test Equipment:
Non-destructive Test Equipment:
Chemical / Physical Laboratory:
Certification / Calibration Laboratory:

AUTHORIZED PERSON COMPLETING SURVEY:
Name:
Title: