22Q0077 CDRL.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item) Form Approved

OMB No. 0704-0188

The 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, Executive Services, Directorate (0704-0188). Please do not return your form to the above organization. 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

A

C. CATEGORY:

TDP TM OTHER NDTI

D. SYSTEM/ITEM

IPS EQUIPMENT RACK

E. CONTRACT/PR NO.

N00253-22-X-XXXX

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

TEST/INSPECTION REPORT

3. SUBTITLE

SHOCK AND VIBRATION TEST

REPORT

17.PRICE GROUP

4. AUTHORITY (Data Acquisition Doc. No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW Paragraph 2.1

6. REQUIRING OFFICE

NUWCDIVKPT

7. DD 250 REQ

SD

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

SEE BLK 16

12. DATE OF FIRST SUBMSSN

SEE BLOCK 16

14. DISTRIBUTION

SEE BLOCK 16

18. ESTIMATED

TOTAL PRICE

8. APP CODE SEE BLK 16 11. AS OF DATE 13. DATE OF SUBSEQ SUBMSSN b. COPIES

N/A N/A N/A a. ADDRESSEE Final

16. REMARKS Draft Reg Repro

NUWCDIVKPT TPOC 1

NUWCDIVKPT PCO 1

NUWCDIVKPT CS 1

15. TOTAL 3

DD Form 1423-1, FEB 2001 Previous editions are obsolete. Page 1 of 1 Pages

BLOCK 4: Contractor report format is acceptable.

BLOCK 8: Government approval is not required.

BLOCK 9: DISTRIBUTION STATEMENT D - Distribution authorized to the U.S. Department of Defense, and U.S. DoD contractors only. Critical Technology: July 2022. Other requests for this document shall be referred to

NUWCDIVKPT.

BLOCKS 10 and 12: CLIN 0001 Shock and vibration analysis- three (3) weeks from date of award.

Options:

CLIN 0002: Shock Testing On-Site Support- From date of option exercise for one (1) year. (see attached SOW for more detail) CLIN 0003: Qty 3 sets (covers EDM plus two shipsets)- four (4) weeks, AOE CLIN 0004: Qty 4 sets (covers four ship sets)- four (4) weeks, AOE CLIN 0005: Qty 5 sets (covers five ship sets)- four (4) weeks, AOE

BLOCK 14: Distribution and submittal shall be by electronic media whenever possible. Electronic deliverables shall be in the following formats:

Text Document: Adobe PDF (.pdf, searchable) or Microsoft Word (.doc) Presentation: Adobe PDF (.pdf, searchable) or Microsoft PowerPoint (.ppt) Spreadsheet: Microsoft Excel (.xls)