A003 DI-SAFT-81563 Accident Incident Report_FD20602400023.pdf
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- Solicitation number
- FA853826R0014
About this file
This is a Contract Data Requirements List (CDRL) on DD Form 1423-1 for contract FD2060-24-00023 with the U.S. Air Force. The document specifies a single data item requirement (A003) for an Accident/Incident Report, which is derived from Air Force Instruction (AFI) 91-204 and referenced in the Performance Work Statement paragraph 5.6.2. The requiring office is 409 SCMS/GUMA, with oversight by Program Manager Jessica Grinstead (jessica.grinstead@us.af.mil) and Engineering point of contact Kameron Kirk (kameron.kirk.1.ctr@us.af.mil).
The accident/incident report must be submitted within 24 hours of any damage occurrence following asset receipt after contract award. Subsequent submissions are required as needed in accordance with AFI 91-207. The data item applies across the performance period including the basic year and four ordering periods (A003-E003), plus five option years (F003-K003). Distribution is limited to PM and Engineering personnel, with zero copies marked as draft and one final copy required. The estimated total price for this data requirement is $0.00. The CDRL was prepared on 8 December 2023 and approved on 3 January 2024.
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Text version
DD FORM 1423-1, FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
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, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above 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:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages DD
A-H, J-K
C-5 FD2060-24-00023
A003 Accident/Incident Report N/A
DI-SAFT-81563 PWS PARA. 5.6.2 409 SCMS/GUMA
LT
N/A B
SEE BLK 16
SEE BLK 16
SEE BLK 16
SEE BLK 16
PM 0 1 0
ENG 0 1
SEE BLK 16
0 2 0
Exhibit Data Item No Performance Period A A003 Basic Year B B003 Ordering Period 1 C C003 Ordering Period 2 D D003 Ordering Period 3 E E003 Ordering Period 4 F F003 Option Year 1 G G003 Option Year 2 H H003 Option Year 3 J J003 Option Year 4 K K003 Option Year 5 NOTE: Changes to office symbols and/or e-mail addresses, when necessary shall be made by letter through the Government CO/ACO without further revision to this CDRL.
BLK 10: IAW AFI 91-204, if damage occurs BLK 11: Once assets have been received after contract award BLK 12: 24 hours after accident/incident BLK 13: As needed, IAW AFI 91-207 Program Manager: Jessica Grinstead/ jessica.grinstead@us.af.mil ENG: Kameron Kirk/kameron.kirk.1.ctr@us.af.mil
NSP
0.00
8 Dec. 2023 3 Jan 2024
1 2
GREEN.ASHLEY.MIC
HELLE.1258041336
Digitally signed by
GREEN.ASHLEY.MICHELLE.1258041336
Date: 2023.12.08 11:40:24 -05'00'
LISTER.WESLEY.
A.1394566558
Digitally signed by
LISTER.WESLEY.A.1394566558
Date: 2024.01.03 14:31:54 -05'00'
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