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[{"$nulls":12},"HC2.05.04.02 Rev. 4 [5/25/04]"]
[]
[]
[null,null,"HARLEY-DAVIDSON PPAP SUBMISSION WARRANT"]
[]
[]
[null,null,"Part Name:______________________________________________",{"$nulls":5},"Part Number:__________________________________"]
[]
[null,null,"Safety and/or",{"$nulls":5},"Engineering Drawing"]
[null,null,"Government Regulation",null,null,"____  Yes","____  No",null,"Change Level___________________________",null,null,"Dated_______"]
[]
[null,null,"Additional Engineering Changes__________________________________________________________________________",{"$nulls":8},"Dated_______"]
[]
[null,null,"Shown on Drawing No.________________________",{"$nulls":3},"Purchase Order No._______________________________________",{"$nulls":4},"Weight______"]
[]
[null,null,"Checking Aid No.______________________________",{"$nulls":3},"Engineering Change Level__________________________________",{"$nulls":4},"Dated_______"]
["                       Supplier to complete this section in accordance with specified H-D PPAP requirements."]
[null,null,"SUPPLIER MANUFACTURING INFORMATION",{"$nulls":5},"SUBMISSION INFORMATION"]
[null,null,"______________________________________________________",{"$nulls":3},"____________",null,"     ____Dimensional",null,"____Materials/Functional"]
[null,null,"Supplier Name",{"$nulls":3},"Supplier Code",null,null,"____Appearance"]
[]
[null,null,"______________________________________________________ ",{"$nulls":5},"H-D Location:_________________________________"]
[null,null,"Street Address"]
[]
[null,null,"______________________________________________________",{"$nulls":5},"Buyer:_________________________________________"]
[null,null,"City/State/Postal Code"]
[{"$nulls":8},"Application:_____________________________________"]
[null,null,"Note: Does this part contain any restricted or reportable substances?",{"$nulls":6},"  _____Yes","  _____","No"]
[{"$nulls":3},"    Are plastic parts identified with appropriate ISO marking codes?",{"$nulls":5},"   _____Yes","  _____","No"]
[]
[null,null,"REASON FOR SUBMISSION"]
[{"$nulls":3},"Initial Submission",{"$nulls":4},"Change to Optional Construction or Material"]
[]
[{"$nulls":3},"Engineering Change(s)",{"$nulls":4},"Sub-Supplier or Material Source Change"]
[]
[{"$nulls":3},"Tooling: Transfer, Replacement, Refurbishment, or Add'l",{"$nulls":4},"Change in Part Processing"]
[]
[]
[{"$nulls":3},"Correction of Discrepancy",{"$nulls":4},"Parts Produced at Additional Locations"]
[]
[{"$nulls":3},"Tooling Inactive > than 1 year"]
[{"$nulls":3},"Other - please specify____________________________________________________________________________"]
[]
[]
[null,null,"REQUESTED SUBMISSION LEVEL  (check one)"]
[{"$nulls":3},"Level 1 - Warrant only (and for designated appearance items, a Cosmetic Validation Report)."]
[]
[{"$nulls":3},"Level 2 - Warrant with product samples and limited supporting data submitted to customer."]
[]
[{"$nulls":3},"Level 3 - Warrant with product samples and complete supporting data submitted to customer."]
[]
[{"$nulls":3},"Level 4 - Warrant and other requirements as defined by customer."]
[]
[{"$nulls":3},"Level 5 - Warrant with product samples and complete supporting data reviewed at supplier's manufacturing location."]
[]
[]
[null,null,"SUBMISSION RESULTS"]
[null,null,"The results for  ",null,"      dimensional measurements",null,"       material and functional tests",null,null,"        appearance criteria",null,"      statistical"]
[null,null,"process package, meet all drawing and specification requirements:",{"$nulls":5},"          ___Yes","___No  (if \"No\" - Explanation Required)"]
[null,null,"Mold / Cavity / Production Process _________________________________"]
[]
[null,null,"DECLARATION"]
[null,null,"I affirm that the samples represented by this warrant are representative of our parts and have been made to the applicable Production Part Approval Process Manual 3rd Edition Requirements.  I further warrant these samples were produced at the production rate of ______ / 8 hours.  I have noted any deviations from this declaration below.                                         EXPLANATION/COMMENTS:_____________________________________________________________________________________________________________________________________________________________________"]
[]
[]
[]
[]
[null,null,"Print Name:________________________________",{"$nulls":3},"Title:_____________________________________",{"$nulls":3},"Phone Number:__________"]
[null,null,"Supplier Authorized Signature:__________________________________________________________",{"$nulls":7},"Date:___________________"]
[]
[null,null,"FOR HARLEY-DAVIDSON USE ONLY"]
[null,null,"Part Disposition",null,"___Approved"," ___Rejected","    ___Other_____________________________________________"]
[]
[null,null,"H-D Name____________________________________________",{"$nulls":4},"H-D Signature:_____________________________",{"$nulls":3},"Date:_______"]
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[null,"FORM SS1    04/20/94"]

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[3]
[4]
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[7]
[8]
[9]
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[13]
[14]
[15]
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["Signature",{"$nulls":3},"Title",{"$nulls":4},"Date"]

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[null,"Instructions for using the PFMEA and Control Plan are in the above."]

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[null,null,"Potential Failure Modes and Effects Analysis (Process FMEA)",{"$nulls":9},"FMEA Number:"]
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["Core Team:_______________________________________________________________________________________________________________________________________________________"]
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["SUPPLIER NAME",{"$nulls":11},"MANUFACTURING LOCATION",{"$nulls":11},"SUPPLIER CODE"]
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["REASON FOR SUBMISSION",{"$nulls":11},"COSMETIC STANDARD \"HC\" NUMBER",{"$nulls":10},"COSMETIC STANDARD REVISION NUMBER"]
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[{"$nulls":3}," ENGINEERING CHANGE",{"$nulls":3}," OTHER AS NOTED IN COMMENTS"]
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[{"$nulls":11},"COSMETIC CHECKLIST                                                                                                                                                  ",{"$nulls":12},"Yes","No","N/A"]
[{"$nulls":11},"1.  Do you have Harley-Davidson supplied cosmetic zones for this part?   "]
[{"$nulls":11},"2.  Do you have a Harley-Davidson supplied cosmetic standard for this part? "]
[{"$nulls":11},"3.  Have any boundary samples or Likert scales been established?"]
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["COMMENTS",{"$nulls":7},"COMMENTS",{"$nulls":7},"DATE",{"$nulls":4},"PHONE NUMBER"]
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[{"$nulls":16},"DESIGN RELEASE ENGINEER SIGNATURE (DEVELOPMENTAL PARTS ONLY)"]
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[{"$nulls":16},"PLATFORM RESIDENT ENGINEER OR P & A CATEGORY MANAGER USE"]
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[{"$nulls":16},"SAMPLE DISPOSITION"]
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[{"$nulls":8},"SAMPLE INSPECTION",{"$nulls":11},"APPROVED"]
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[{"$nulls":8},"SAMPLES CONFORM TO STANDARD",{"$nulls":11},"APPROVED - ECN REQUIRED"]
[]
[]
[{"$nulls":8},"SAMPLES DO NOT CONFORM TO STANDARD",{"$nulls":11},"REJECTED"]
[]
[]
["DATE",{"$nulls":3},"PHONE NUMBER",{"$nulls":3},"DATE",null,null,"PHONE                                                       NUMBER",{"$nulls":4},"DATE",{"$nulls":4},"PHONE NUMBER"]
[]
["ORIGINATOR SIGNATURE",{"$nulls":7},"COSMETIC COMMITTEE REPRESENTATIVE / INSPECTOR SIGNATURE",{"$nulls":7},"PLATFORM RESIDENT ENGINEER OR P & A CATEGORY MANAGER SIGNATURE"]