1048V100-00153-AA - BREAKING STREGTH CERTIFIATION CDRL DI-MISC-80678 REV 06-27-2017.pdf
Data Item Description Jun 27, 2017 PDF 998 KB Posted
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- HIGH INTEGRITY CONTAINER
- Solicitation number
- N4523A21Q4065
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CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
Form Approved
OMB No. 0704-0188
Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302.
Please DO NOT RETURN your form to either of these address. Send completed form to the Government issuing Contracting Officer for the Contract/PR No. Listed in Block E.
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TBD A
TDP ___________ TM _______________ OTHER MISC
____________________________________ D. SYSTEM/ITEM
FY-2021 HIC PURCHASE
E. CONTRACT/PR NO.
TBD
F. CONTRACTOR
TBD
DATA ITEM NO.
A003
2. TITLE OF DATA ITEM
CERTIFICATION/DATA REPORT
3. SUBTITLE
BREAKING STRENGTH CERTIFICATION
4. AUTHORITY (Data Acquisition Document No.)
DI-MISC-80678
5. CONTRACT REFERENCE
SOW PARAGRAPH 4.3.4.1
6. REQUIRING OFFICE
PSNS & IMF C/2305.3
7. DD 250 REQ
DD
9. DIST STATEMENT
REQUIRED
D*
10. FREQUENCY
OTIME
12. DATE OF FIRST
SUBMISSION
ASREQ*
14. DISTRIBUTION
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
A. ADDRESSEE
Final
N/A Draft Reg Repr o
16. REMARKS
Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only. Administration and operations only, effective 7/14/2021. Other U.S. requests shall be referred to COMNAVSEASYSCOM.
Block 12: Personnel Qualifications and Test Procedures, when ordered on separate contract line item, shall be submitted and approved before testing unless otherwise specified in contract.
Block 12 – Certification/Data Report documentation shall be submitted via Wide Area Workflow (WAWF) e-Business Suite: Invoice, Receipt, Acceptance, and Property Transfer (iRAPT). iRAPT email notification shall be sent to:
PSNS.WAWFQACertifications.FCM@navy.mil upon submission.
CERTIFICATE OF COMPLIANCE DOCUMENTATION SHALL ALSO BE SUBMITTED
WITH THE SHIPMENT OF THE MATERIAL TO THE DELIVERY ADDRESS SUPPLIED:
RECEIVING OFFICER BLDG 514, ATTN: CODE C/2305
PUGET SOUND NAVAL SHIPYARD & INTERMEDIATE MAINTENACE FACILITY
1400 FARRAGUT AVE, BREMERTON, WA 98314-5001
PSNS & IMF
C/2305*
0 1 0
PSNS & IMF* 0 1 0
TOTAL 0 2 0
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
/s/Peter J. Morgan, C/980 S.2
7/14/2021 /s/ Richard J. Balter C/980 S.2
7/14/2021
DD Form 1423-1, FEB 2001 Previous edition may be used. Page 1 of 2 Pages
Document No: 1048-V100 / JO# 69M44-HICMN-S01 / Item# 800
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
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