ASQR-01 from 6 Distributor Survey

UTC Distributor Request
ASQR-01 Form 9

Supplier shall request and obtain approval using ASQR-01 Form 9 prior to the use of any distributor not on the UTC Qualified Distributor List when procuring metals, electronics, and hardware from a distributor. Note: Manufacturers of distributed parts do not need to be on the QDL.

Electronics include electrical, electronic, and electro-mechanical components (e.g., connectors, wire, electronic components, terminals, lugs, pc boards, semiconductors).

Hardware includes fasteners (e.g., nuts, bolts, rivets, washers, pins, screws, clamps), springs, seals (e.g., o-rings), ferrules, and fittings.

Metals include metallic raw materials (e.g., bar, sheet, plate, tube, wire, forging, casting, billet, ingot).

Process Step / Activity / Owner / Additional Guidance
0 / Review current Qualified Distributor List (QDL) for current approvals / Supplier / Qualified Distributor List

1 / Complete ASQR-01 FORM 9
. / Supplier / Aerospace Supplier Quality Requirement Documents

Supplier confirms the distributor meets the requirements in accordance with ASQR-01. Answers to all questions in the QDL Requirements Section below must be “yes” in order to be considered for approval.
2 / Submit the Form 9 / Supplier / Once completed, submit the form 9 to .
To avoid unnecessary costs, suppliers should validate the Business Justification and ensure all QDL Requirements are met prior to initiating a
3 / Initiate / UTC QDL Process / UTC QDL process will initiate a report in the 3rd party system. A link will be emailed to you.
4 / Perform / Supplier/ Distributor / Supplier/Distributor is responsible for the Trace report.

Note: Distributors of electronics, hardware and metals to any UTC Member and/or member of their respective supply chains must meet the requirements contained herein in order to be considered for approval to the UTC QDL. Suppliers must confirm that distributors they want to addto the UTC QDL meet these requirements.

Form 9 and TRACE check to be completed in full prior to being submitted.

Supplier’sUTCVendor Code(s): (Only one vendor code required per division where applicable)

PWC PWA UTAS: APS ASG INT LS ES SIS

Checklist Completed By:

Date Submitted:

Email Contact:

Phone Number:

Member PO Supplier Name:

(Name of Supplier holding PO from UTC Member) /

DUNS #:

Supplier Address:

OIN (Oasis) #:

Distributor Commodity:

(Check all that apply)

Metals

Electronics

Hardware

Name of Distributor the Supplier is requesting toadd:

Distributor Website Address:

Distributor Address:

Phone Number:

Distributor Email:

DUNS #:

Trace-Check Process completed:

OIN (Oasis) #:

Is this form being submitted due to a name or address change?

If yes, what was the previous name?
Business Justification:
Prior to submitting this form, please review the list of currently approved distributors (
UTC recommends suppliers utilize existing UTC approved distributors.
Please indicate why an approved distributor on the UTC QDL cannot be used.
Answer:
Quality System Evaluation:

Is the distributor AS9100 or AS9120 certified?

Yes No

If not AS9100/AS9120 certified, is the distributor ISO 9001 certified and willing to become certified to AS9100/AS9120 within 12 months?

Yes No

If not, is the distributor a franchised/authorized distributor (defined as: a contractual arrangement with or having the expressed written authority of, the original manufacturer or current design responsible party to buy, stock, sell the part) and only supplies parts and material that is new or previously unused (not comingled with used, refurbished, reclaimed or returned parts)?

Yes No

If not, does the distributor obtain parts exclusively from the original manufacturer or authorized supplier and only supplies parts and material that is new or previously unused (not comingled with used, refurbished, reclaimed or returned parts)?

Yes No
Requirements:
1 / Does the distributor (a) have a Code of Conduct or policy statement regarding business ethics which, at a minimum, meets the requirements set forth in UTC's Supplier Code of Conduct (found here)?
Yes No
2 / If the distributor purchases product from other distributors, does it have a process in place to only procure metals, electronics and hardware destined for use in UTC member product, from distributors on the UTC Qualified Distributor list?
Yes No / Objective Evidence
3 / Does the distributor have a process in place to (a) institute/implement UTC and UTC member requirements and has committed to contractually flowing down all UTC and UTC member requirements to its suppliers of UTC member product and (b) ensure when product specifications and/or contractual requirements are added or amended by its customers that its relevant documents are amended and flowed down internally and to its supplier chain??
Yes No / Objective Evidence
4 / Hasthe distributor established and ismaintaining a Counterfeit Parts and Material Prevention Program with a continuously updated Control Plan using AS5553, AS6174 and/or AS6081, as appropriate for each commodity that it provides, to ensure that counterfeit parts and materialare not delivered.
Yes No / Objective Evidence

For UTC Use Only

Trace-Check Report Received:

Trace-Check Report Approved:

Approved:

Rejected: dddd

Comments:

UTC Distributor Survey

This document contains no technical data subject to the EAR or the ITAR

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