A004 - ECIS MOB CPSR FINAL.pdf

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 1 of 1

CONTRACT DATA REQUIREMENTS LIST (CDRL)

(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 the Department of Defense, Executive Services Directorate (0704-0188). 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 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 C. CATEGORY:

A TDP _____ TM ___ OTHER SUSTAINMENT DATA

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

ECIS N61340-21-R0048

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

A004 TECHNICAL REPORT: STUDY/SERVICES MOBILIZATION CI CONTRACT PERFORMANCE

SUMMARY REPORT

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

DI-MISC-80508B SEE BLK 16 NAWCTSD

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT REQUIRED BI-WE SEE BLK 16

a. ADDRESSEE

b. COPIES

8. APP CODE

B

11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft Final

SEE BLK 16 Reg Repro

16. REMARKS: NAWCTSD PJM 1 1

1. BLK4: ONLY DID PARAGRAPH 3.9(C)(2) APPLIES.

2. SEE ANNEX A004 FOR SAMPLE REPORT CONTENTS.

3. BLK 5: SEE PWS PARAGRAPH 2.1.3 and 3.2.1

4. BLK 12 & BLK 13: MOBILIZATION CI CONTRACTOR PERFORMANCE SUMMARY

REPORTS ARE REQUIRED DURING THE MOBILIZATION PERIOD AND SHALL BE

SUBMITTED TO THE COR FOR SIGNATURE THE FRIDAY OF THE SECOND (2ND) AND

FOURTH (4TH) FULL FIVE-DAY (MONDAY – FRIDAY) WORKING WEEK OF EACH

MOBILIZATION MONTH. DISTRIBUTION COPIES VIA EMAIL ARE DUE WITHIN THREE

(3) DAYS AFTER RECEIPT OF COR SIGNATURE.

5. THE GOVERNMENT WILL HAVE SEVEN (7) WORKING DAYS FOR REVIEW AND

ACCEPTANCE/REJECTION OF EACH SUBMISSION. NO RESPONSE WILL INDICATE

ACCEPTANCE.

6. BLK 14: REPORTS FOR COR ADDRESSEES SHALL BE DISTRIBUTED ONLY TO THE

RESPECTIVE COR’S SITE. SUBMISSIONS SHALL BE AN EMAIL ATTACHMENT IN

MICROSOFT® OFFICE 2016 (OR LATER) COMPATIBLE FORMAT AND SHALL

INCLUDE IN THE SUBJECT LINE: CONTRACT NUMBER, CDRL DATA ITEM NUMBER,

AND PERIOD (E.G.; N6134020F00XX-A004/13-17JAN2020). EMAIL ADDRESSES ARE

PROVIDED IN THE CONTRACT SCHEDULE AND/OR THE CDRL ADDRESSEE LIST

(ATTACHMENT 3 OF THE CONTRACT).

7. BLK 9: THE FOLLOWING STATEMENT SHALL BE INCLUDED ON THE DELIVERABLE:

DISTRIBUTION B: DISTRIBUTION AUTHORIZED TO U.S. GOVERNMENT

AGENCIES ONLY, ADMINISTRATIVE OR OPERATIONAL USE, 14 JANUARY

2020. OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED TO

THE COMMANDING OFFICER, NAVAL AIR WARFARE CENTER TRAINING

SYSTEMS DIVISION, IN-SERVICE SUPPORT DIVISION, 12211 SCIENCE DRIVE,

ORLANDO, FL 32826-3224.

NAWCTSD PCO 1

NAWCTSD Sustainment 1 1

COR Great Lakes 1

COR Newport 1

COR Norfolk 1

COR Pearl Harbor 1

COR San Diego 1

COR ZTF, San Diego 1

COR SLC, New London 1

15. TOTAL ▬▬▬▬► 2 10

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

R. SMITH, NAWCTSD Sustainment 02/10/2021 C. CAUDILL NAWCTSD PJM 04/22/2021

ANNEX TO EXHIBIT A004

MOBILIZATION COMS/CMS CONTRACTOR PERFORMANCE REPORT

ECIS CDRL REQUIREMENT

1.0 Report Contents.

1.1 Header Information. Data elements to be provided as header information are as follows, in the order shown.

a. Contract. Enter appropriate contract number.

b. Contractor. Enter name of contractor's firm.

c. Reporting Period. Enter month and year for which report is being prepared.

1.2 Report Body.

1.2.1 This report documents and summarizes status and performance for the ECIS contract for Contractor

Instruction (CI) Services. The main body of the report shall be completed in accordance with the attached sample format. Block 16 of each Contract Data Requirements List (CDRL) shall tailor each reports requirements by applying the annex paragraphs delineated in annex paragraph 2.0 (a through g). Entry of actual data is to be made in the appropriate column for the period covered by the report. Refer to Performance Work Statement (PWS), Addendum B for definition of terms.

1.3 Format. The report shall include up to six parts as specified in the contract and the CDRL. The summary shall be presented in columnar format to facilitate reporting of data on multi-station devices/equipment items or where multiple devices/equipment items are collocated (refer to applicable samples). Any of the following formats may apply as per block 14 and 16 of the CDRL:

1.3.1 Hard Copy. Where applicable, individual areas shall be prepared as delineated in the contract on 8 ½” by 11” to 11” by 17” size paper.

1.3.2 Magnetic Media. Where applicable, individual area files shall be placed on Compact Disc Recordable/Re-

Writable (CD-R/CD-RW; 1x-4x drive capable media) optical disc. Magnetic files shall be compatible to Microsoft® Office formats as specified in block 16 of the CDRL.

1.3.3 E-Mail. Reports shall be attached files to Internet Electronic Mail that are compatible with Microsoft®

Office formats as specified in block 16 of the CDRL.

2.0 Summary Report Content. The CI Contractor Performance Summary Report can consist of all or a portion of the following (as specified in the CDRL):

a. CI Contractor Performance Summary Report Definition of Terms

b. Part I - CI Contractor Performance Summary Report (Over-all Weapon System Site Summary)

(Annex paragraph 2.2 – figure 1)

c. Part II - CI Contractor Performance Summary Report (Instruction Units Summary) (Annex paragraph 2.3 – figure 2)

d. Part III - CI Contractor Performance Summary Report (Instruction Units Summary Breakout)

(Annex paragraph 2.4 – figure 3)

e. Part IV - CI Contractor Performance Summary Report (CI Additional Time Utilization Report)

(Annex paragraph 2.5 – figure 4)

2.1 Figure Block Definitions/Format.

2.1.1 Part I: Figure 1 (Overall Weapons System Site Summary) for CDRL Annex Section 2.2.

Header:

a. Date of Report. Enter date report is prepared (e.g., ddmmyy).

b. From. Enter Contractor site manager‘s name and full address.

c. Contract Name. Enter full contract number (e.g., N61340-11-D-0099).

d. Contractor Name/Cage Code. Enter full name of prime contractor and Command and Government

Entity (CAGE) code.

e. CLINs/SLIN/s. Enter the applicable contract line items (CLIN)/sub-line items (SLIN) that apply to the CI Technical Data and Information (CDRL 1423-1) and CI service.

f. CDRL Number. Enter the data item number from the Contract Data Requirements List (CDRL) DD Form 1423-1 for this report (e.g., A006).

g. CDRL Title. Enter the title and sub-title of data item of the Contract Data Requirements List (CDRL) DD Form 1423-1 for this report (e.g., Technical Report-Study/Services/ CI Contractor Performance Summary Report).

h. Weapon System(s). Enter name of weapon system(s) associated with the training (e.g., EA-6B).

i. Command/Location. Enter name of government command (s) and location where training is accomplished.

j. Classification of Report. Enter the security classification of this report (e.g., UNCLAS, Confidential, Secret, Top Secret).

k. Reporting Period. Enter the date of the first and last day of the reporting period (e.g., ddmmyy to ddmmyy).

l. Summary of Reporting Period. Provide narrative of completed tasks, on-going projects, issues, status of training. If the reporting period is the mobilization period, include status of key requirements (hiring status, training, inventory, resumes, etc).

m. Signature of Contractor Site Manager. Print name, insert electronic signature and date of signature.

n. Signature of COR. Print name, insert electronic signature and date of signature.

o. COR Remarks. Check the applicable block (COR remarks attached or no COR remarks attached).

p. Contract Personnel. On a separate report sheet (page), provide list of contractor personnel on site providing: name, DOL of position title, areas/dates trained and certified to instruct, employment status (full/part-time), and DOL anniversary date.

(1) Name of employee

(2) Position (Site Manager (SM), Assistant/Alternate Site Manager (ASM), Lead Instructor (LI)

(3) Type of Contract Instructor (CI): (Pilot (CIP), Naval Flight Officer-NFO (CIN), Aircrew

(CIA)

(4) Dept of Labor (DOL) Wage Grade Category Number

(5) Full time (FT) or Part time status (PT)

(6) Employment Anniversary Date (DDMMMYY) for pay

(7) Initially On-board Date – date reported on working site for employment

(8) Training Start Date (ddmmmyy)

(9) Certification Date (ddmmmyy)- date individual is certified as CI (in writing from government) and/or date anticipated to be certified per training track –ddmmmyy *Est)

(10) Level of Security Clearance/Access (e.g., Secret). Must meet requirements of PWS

(11) Weapons System

(12) Remarks: Note if new employee or any dates of termination and dates badges are turned in.

(Position title, areas/dates trained and certified to instruct, employment status (full/part-time), and DOL anniversary date)

2.1.2 Part II: Figure 2 - CI Contractor Performance Summary Report (Instruction Units). For CDRL Annex

Section 2.3 Complete for each Contract Instructor Type for each site/weapon system (e.g., one for SH-60B, North Island, CA CIP, one for SH-60B, North Island, CA CIN).

a. CDRL #. Enter the data item number of the Contract Data Requirements List (CDRL) DD Form

1423-1 for this report (e.g., A006).

b. Contractor Name. Enter full name of prime contractor.

c. Contract Name. Enter full contract number (e.g., N61340-11-D-0099).

d. Command/Location. Enter name of government command, station and location where training is accomplished.

e. Weapon System(s). Enter name of the weapon system(s) associated with the applicable reported training (e.g., EA-6B).

f. Type of Instructor. Enter the type of contract instructor (e.g., Pilot/CIP, NFO/CIN, Aircrew/CIA).

g. Fiscal Year (LOT). Enter the Fiscal year and schedule B LOT #applicable to the reporting period.

h. Start of Reporting Period. Enter ddmmyy for the first day of the reporting period for the applicable month column.

i. End of Reporting period. Enter ddmmyy for the last day of the reporting period for the applicable month column. Complete for each reporting period for each type of Contract Instructor (CI) (e.g., CIP, CIN, CIA).

j. Instruction Units Contracted. Enter the total number of instruction units contracted per the PWS for the reporting period. (Instruction Units Contracted = INS + IS)

k. Contracted Instruction Units Not Scheduled (INS). Enter the number of Instruction Units Contracted minus the Instruction Units Scheduled.

l. Instruction Units Scheduled (IS). Enter the total number of contracted instruction units scheduled during the reporting period. (IS = IC+LI+CLI)

m. Instruction Units Completed (IC). Enter the total number of scheduled instructional units completed during the reporting period.

n. Non-chargeable Lost Instruction Units (LI). Enter the total number of instruction units lost for the reporting period that are not chargeable to the contractor as defined in the PWS (e.g., device down, student fails to show up).

o. Chargeable Lost Instruction Units (CLI). Enter the total number of scheduled instruction units lost for the reporting period that are chargeable to the contractor as defined in the PWS (e.g., CI instructor fails to complete or show up for a scheduled instruction unit).

p. Instruction Factor (IF). Percent value derived from the performance algorithm specified in the PWS.

q. CI Instruction Units Contracted: Enter how the units are defined per the PWS (e.g., Hours-per-day

(HPD) or Hours-per-month (HPM)). Specify the number of HPD/HPM and on which days the week (e.g., Mon-Fri, Sat-Sun) as specified in the PWS.

r. Remarks: Any applicable remarks.

s. Cumulative To Date Total: Add cumulative totals for each row. This should be accurate up to the last report period.

2.1.3 Part III: Figure 3 - CI Contractor Performance Summary Report (Instruction Units Breakout) for annex section 2.4. Complete for each Contract Instructor Type for each site/weapon system (e.g., one for SH-60B, North Island, CA CIP, one for SH-60B, North Island, CA CIN).

a. CDRL title and #. Enter the data item number of the Contract Data Requirements List (CDRL) DD

Form 1423-1 for this report (e.g., A006).

b. Contract Name. Enter full contract number (e.g., N61340-11-D-0099 TO 0001).

c. Contractor Name. Enter full name of prime contractor.

d. Weapon System(s). Enter name of the weapon system(s) associated with the applicable reported training (e.g., EA-6B).

e. Command/Location. Enter name of government command, station and location where training is accomplished.

f. Start of Reporting Period. Enter ddmmyy for the first day of the reporting period for the applicable month column.

g. End of Reporting period. Enter ddmmyy for the last day of the reporting period for the applicable month column.

h. CLIN/SLIN #. Applicable CLIN/SLIN for the weapon system/site/type of Contract Instructor.

i. Type of Contract Instructor (s). Enter the type of contract instructor (e.g., Pilot/CIP, NFO/CIN, Aircrew/CIA, etc.).

j. Instruction Unit Breakout. For each type of CI and Primary Responsibility scheduling areas, provide following data for the reporting period:

k. Instruction Units Contracted for the Report Period. (only applied to reporting period Total for each

CI Type)

l. Contracted Instruction Units Not Scheduled (INS). (only applies to reporting period Totals for each

CI Type)

m. Instruction Units Scheduled (IS), Instruction Units Completed ((CI), Non-Chargeable Lost

Instruction Units (LI), Chargeable Lost Instruction Units (CLI) and Instruction Factor (IF). (Only applies to reporting period Totals for each CI Type).

n. Break out data in the following Primary Responsibility scheduling areas:

1. Column a: Trainer/Device Instruction and/or Operations – The number of Primary Instructor

Units the Contract Instructor (CI) provides for scheduled trainer/simulator trainee instruction AND trainer/simulator operator services (including brief and debrief).

2. Column b: Classroom Instruction - The number of Primary Instructor Units the CI provides scheduled classroom instruction services.

3. Column c: Syllabi/Curriculum Updates/Maintenance - The number of Primary Instructor Units the CI provides scheduled SME: update/maintenance services. Specify/explain duties/accomplishments in contractor remarks section.

4. Column d: Other Scheduled Duties - The number of Primary Instructor Units that the contractor CI provides scheduled other duties (not included in columns a-c duties) that are defined in Addendum B of the PWS. Specify/explain duties/accomplishments in contractor remarks section.

o. Units. Identify the units of measure for the Primary Responsibility scheduling areas.

p. Contractor Remarks. General remarks as applicable about reporting period and explain what was accomplished when SME and Other hours are used.

q. Signature of Contractor Site Manager and date. Print name, insert electronic signature and date of signature.

r. Signature of COR and date. Print name, insert electronic signature and date of signature.

s. COR Remarks. Enter remarks as may be applicable.

2.1.4 Part IV: Figure 4 - CI Contractor Report Additional Time (AT) Utilization Report for annex section 2.5.

a. Signature of Contractor Site Manager. Print name, insert electronic signature and date of signature.

b. Signature of COR. Print name, insert electronic signature and date of signature.

c. Contract Name. Enter full contract number (e.g., N61340-11-D-0099).

d. CDRL #. Enter the data item number of the Contract Data Requirements List (CDRL) DD Form

1423-1 for this report (e.g., A006).

e. Command/Location. Enter name of government command, station and location where training is accomplished.

f. COR Remarks. Any applicable remarks.

g. Reporting Period. Enter the date of the first and last day of the reporting period (e.g., ddmmyy to ddmmyy).

h. Column 1 Additional Time (AT) CLIN/SLIN Number. Enter CLIN/CLIN for the applicable premium time.

i. Column 2 AT Used this Reporting Period. Enter number of hours of premium time used against the

CLIN/SLIN in column 1.

j. Column 3 Cumulative AT used for the applicable report period LOT/Fiscal Year. Self Explanatory.

k. Column 4 AT CLIN/SLIN Unit Price. Entered $/hour unit price for the applicable CLIN/SLIN in column 1.

l. Column 5 AT Funds Expended. The product of column 3 times column 4.

m. Column 6 AT CLIN/SLIN Funded Amount. The amount of funds obligated on the applicable

CLIN/SLIN in column 1.

o. Column 7 AT Funding Balance. The value of column 6 minus column 5.

p. Column 8 Percent of AT Funds Remaining. The percent value derived by the product of 100 times the quantity of column 7 divided by column 6.

q. Total: Enter the total for each column 1 through 7 on the bottom row.

CI CONTRACTOR PERFORMANCE SUMMARY REPORT (Overall Site Summary):

Date of Report:

ddmmyy

From: Site Manager (name and address) To: COR (name and address) Contract#: N61340-13-C-5101 Contractor Name/Cage Code : ABC Inc/9999 Command/ Location: NAS Billing VF-111, Billing, FL CLIN (s)/SLIN(s): ####,####,#### Classification of Report: UNCLASS CDRL Number: A006 Reporting Period: ddmmyy to ddmmyy

CDRL Title/Sub-title: Mobilization CI Performance Summary Report

Summary of Reporting Period:

- Summary of Issues/On-going Project;

completed tasks; status of training

- Significant accomplishments

- Mobilization status

- Other

Signature of Contractor Site Manager:

Date:

(print name and enter electronic Site Manager signature)

Signature of Government COR/ACOR:

Date:

(print name and enter electronic COR signature)

COR Remarks:

CONTRACTOR PERSONNEL ( NOTE: Restricted Information; FOUO):

NAME:

Position

(SM /

ASM/LI) Type CI DOL CAT

FT/PT

Status:

Employment Aniv Date (for pay)(ddmmmyy)

Initial On-board date

Training Start date

Certif Date/ Trg Track Est *

Security Clear/

Access

Wep System

(if applicabl

e) Remarks (Note: end date of any employment; badges turned in)

1. Smith, John (SAMPLE) SM CIP 29100 FT 1-Oct-04 1-Nov-05 1-Nov-05 1-Jan-06 Secret

SH-60F

HH-60H Incumbent from previous contract

2. Adams, David (SAMPLE) LI CIP 29100 PT 1-Nov 04 1 –Dec 05 1-Dec-05

60F 1Jan 05 60 H *Est.

1 Feb 05 Secret

SH-60F

HH-60H New Employee

3.

4.

5.

6. Add lines as needed

Figure 1 – SAMPLE CI Contractor Performance Summary Report (Over-all Site Summary/Personnel)

Figure 2 - CI Contractor Performance Summary Report SAMPLE (Format Option One for Instruction Units):

CI CONTRACTOR PERFORMANCE SUMMARY REPORT (Instruction Units):

CDRL #: A006 Contractor Name: ABC Inc/9999 Contract #: N61340-13-C-5101 CMD Location: NAS Billing VF-111, Billing, FL Type of Instructor (s): CIP and CIN Weapon System: F-44

Fiscal Year: FY-09

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Cumulative

START of Reporting Period: ddmmyy 011005 To Date

END of Reporting Period: ddmmyy 311005

TOTAL:

CIP Instruction Units Contracted for Rprt Period

(# hrs) 200 200

CIP Contracted Instruction Units Not Scheduled (INS)

(# hrs) 100 100

CIP Instruction Units Scheduled (IS)

(# hrs) 100 100

CIP Instruction Units Completed (IC)

(# hrs) 90 90

CIP Non-chargeable Lost Instruction Units ( LI )

(# hrs) 5 5

CIP Chargeable Lost Instruction Units (CLI)

(# hrs) 5 5

CIP Instruction Factor (IF) (percent)

(%) 95% 95%

CIP Instruction Units Contracted for:

[ x ] _40_Hours per day (HPD) [ ] ___# Hours per month (HPM) [ ] Other ____________ Mon-Fri

CIN Instruction Units Contracted for Rprt Period

(# hrs) 200 200

CIN Contracted Instruction Units Not Scheduled (INS)

(# hrs) 100 100

CIN Instruction Units Scheduled (IS)

(# hrs) 100 100

CIN Instruction Units Completed (IC)

(# hrs) 90 90

CIN Non-chargeable Lost Instruction Units (LI)

(# hrs) 10 10

CIN Chargeable Lost Instruction Units (CLI)

(# hrs) 0 0

CIN Instruction Factor (IF) (percent)

(%) 100% 100%

CIN Instruction Units Contracted for:

[ x] _40_Hours per day(HPD) [ ] ____ Hours per month (HPM) [ ] Other ____________ Mon-Fri

Remarks: Using sample IF performance algorithm - IF= ((IC+LI) x100) / IS ;

Contracted Instr Units=I NS + IS ;

IS = IC + LI + C L

CI CONTRACTOR PERFORMANCE SUMMARY REPORT (Instruction Units Breakout) CDRL Title: (Month) CI Contractor Performance

Summary Report

CDRL #: A004

Contract#: N61340-21-C-5101 Contractor Name: ABC, Inc.

Weapon System: F-44 Command(s)/Location: NAS Billing, VF-100, Billing, FL

START of Reporting Period):

ddmmyy END of Reporting Period: ddmmyy

CLIN/SLIN:

CIP-

CIN-

Units: Trnr/ Device Instruction:

Classroom Instruction:

SME: Syllabi/ Curriculum Updates/ Maintenance (Note:

Specify in remarks)

Other (Note: Specify in remarks):

Total:

CI Type>>>: >>>> CIP CIN CIP CIN CIP CIN CIP CIN CIP CIN Instruction Units Contracted for Rprt Period (Prim + AT)

(#) XXX XXX XXX XXX XXX XX X XXXX XXX 200 200

Contracted Instruction Units Not Scheduled

(INS)

Hrs

XXX XXX XXX XXX XXX XXX XXXX XXX 100 100

Instruction Units Scheduled (IS)

Hrs

50 50 20 30 30 20 0 0 100 100

Instructional Units Completed (IC)

Hrs

75 75 10 10 5 5 0 0 90 90

Non-chargeable Lost Instruction Units (LI)

Hrs

5 10 0 0 0 0 0 0 5 10

Chargeable Lost Instruction Units

(CLI)

Hrs

5 0 0 0 0 0 0 0 5 0

Instruction Factor

(IF)

(%) XXX XXX XXX XXX XXX XXX XXXX XXX 95% 100

Contractor Remarks: Specify for “SME” and “Other” Site Manager Signature: (print name) Date: ddmmyy (enter electronic Site Manager signature)

COR/ACOR Signature: (print name) Date: ddmmyy (enter electronic COR signature)

Figure 3 - CI Contractor Performance Summary Report SAMPLE (Format Option One for Instruction Units Breakout):

2.5 Part IV: The Additional Time (AT) Utilization Report applies at any site where there is an Additional Instruction Time requirement. This part details the data described in CDRL Annex paragraph 2.1.4.

CI CONTRACTOR ADDITIONAL TIME (AT) UTILIZATION REPORT:

Signature Site Manager:

(print name and electronic Site Manager signature)

Date: ddmmyy

Signature COR:

(print name and enter electronic COR signature) Date: ddmmyy

CDRL Number:: A006 Contract #: N61340-13-C-5101 Command(s)/Location: NAS Billing,VF-100, Billing

FL

Report Period:

ddmmyy to ddmmyy

Col 1 Col 2 Col 3 Col 4 Col 5 Col 6 Col 7 Col 8

AT CLIN/

SLIN

Number

AT Used This Reporting Period (hrs)

Cumulative AT Used for

LOT__/FY__

(hrs)

AT CLIN

Unit Price ($/Hr)

AT FUNDS

Expended [Col 3 * Col 4]

AT CLIN

Funded Amount

AT Funding Balance [Col 6-Col 5]

Percent of AT Funds Remaining

TOTALS:

Figure 4 - Sample CI Contractor Performance Summary Report

[Additional Time Utilization Report]

END of Reporting Period: