22Q7058 Exhibit A.pdf

245.2H-1195-22 / 22244001-2 PAGE 3 OF 5

CONTRACT DATA REQUIREMENTS LIST Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 440 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 this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704- 0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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 X TM _________ OTHER _____________________________

D. SYSTEM / ITEM E. CONTRACT / PR NO.

22244001-2

F. CONTRACTOR

Cable Assemblies

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

A001 Certification of Compliance Certification of Compliance

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE DI-MISC-81356A Section C.2 245.2

7. DD 250 REQ

DD

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

One Time

12. DATE OF FIRST SUBMISSION

W/Material

14. DISTRIBUTION

b. COPIES

8. APP CODE 11. AS OF DATE

13. DATE OF SUBSEQUENT SUB

a. ADDRESSEE

Draft Final

Reg Repro

16. REMARKS

a) Vendor to provide Certificate of Compliance that all applicable drawings and notes were followed

b) For Payment & Submission of Data refer to Clauses 252.232-7006 & 252.232-7003 or 52.232-36. Each Data Item Submitted by Vendor must be submitted under a Separate Shipment Number.

CODE 133.2 0 1 0

0 0 0

15. TOTAL

0 1 0

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

A002 Testing/Inspection Results Test Results

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-80678

5. CONTRACT REFERENCE

Section C.2

6. REQUIRING OFFICE

Code 245

7. DD 250 REQ

DD

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

One Time

12. DATE OF FIRST SUBMISSION

W/Material

14. DISTRIBUTION

b. COPIES

8. APP CODE 11. AS OF DATE

13. DATE OF SUBSEQUENT SUB

a. ADDRESSEE

Draft Final

Reg Repro

16. REMARKS

a. Paragraphs 10.2.2, 10.2.3, and 10.4 of DI-MISC-80678 do not apply.

b. Vendor to provide the Government with testing and inspection results on all Cable Assemblies IAW

MIL-DTL-24231E(SH) dtd 26APRIL2013 table 1 conformance type 1.

c. For Payment & Submission of Data refer to Clauses 252.232-7006 & 252.232-7003 or 52.232-36.

Each Data Item Submitted by Vendor must be submitted under a Separate Shipment Number.

CODE 133.2 0 1 0

0 0 0

15. TOTAL

0 1 0

G. Prepared By: H. Date I. Approved By: J. Date

Lane Hug x3873

8-12-22 X

8/12/22

DD FORM 1423, JUNE 90 Previous editions are obsolete Page __1__ of __1__ Pages

17. PRICE GROUP

17. PRICE GROUP