A006 CDRL 006 Shipboard Asbestos-Containing Material (ACM) Report.pdf

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 the Department of Defense, Executive Services (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 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.

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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

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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

0003 A006

Asbestos Containing Material (ACM) Report

DI-SAFT-82081 Section C-1, Para. 11.6

See Block 16 See Blk. 16

See Blk. 16 MSC Guam N7 2 MSC Guam N10 2 Ship's Force 5 MSC Principle Port Eng 1

0 10 0

Frequency: As specified in the Delivery Order (DO).

Date of First Submission: As specified in the DO.

Date of Subsequent Submission: As specified in the DO.

Format: Submit using Contractor's format in electronic media.

Adobe Professional 8.0

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP ________ TM _______ OTHER

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

16. REMARKS (Continued)

DD FORM 1423-1, FEB 2001 Page of Pages

0003 A006

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

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Item G. Signature of preparer of CDRL.

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Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

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Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

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Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.

DD FORM 1423-1 (BACK), FEB 2001

DATA ITEM DESCRIPTION

Title: Shipboard Asbestos-Containing Material (ACM) Report

Number: DI-SAFT-82081

AMSC Number: N9733

DTIC Applicable: No

Preparing Activity: SH

Applicable Forms: N/A

Approval Date: 20161004

Limitation: N/A

GIDEP Applicable: No

Project: SAFT-2016-012

Use/Relationship: This DID will provide documentation that the contractor is in compliance with the requirements for controlling the shipboard handling and removal of ACM.

This DID contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

Requirements:

Format. The report shall be in the contractor’s format.

Content. The report shall include the following:

Notifications made to regulatory authorities, regarding ACM removal.

Written notice for each job/separate area of ACM removed/damaged aboard ship where there may be ACM shall contain:

Ship’s name and hull number

Work Item number

Compartment

Class of activity and type of insulation, lagging, deck tile, underlayment, and mastic, i.e., ACM or possible ACM (provide basis for determination)

Date and time to start work

List of regulated areas, decontamination areas, and engineering controls to be established.

Results of lab analysis of air monitoring certifying the area to be less than 0.1 asbestos fibers longer than 5 micrometers per cubic centimeter of air.

End of DI-SAFT-82081

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