1048V100-00153-AA - BREAKING STREGTH CERTIFIATION CDRL DI-MISC-80678 REV 06-27-2017.pdf

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