APOBS_CDRL_A003_CoC_v1_eSigned.pdf

CONTRACT DAT A REQUIREMENTS LIST Form Approved (1 Data Item) 0MB No. 0704-0188

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Washi ?fil on Headqua�ers Services, Directorate for Informat ion pe ns and ReP.Orts (0701-0188), 15 efferson Davis Highway, Suite 120 , Arlington, VA 2202-4 2. Respondents should be aware that

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

QCIC

003 A TDP TM OTHER

D.SYSTEM/ITEM

I

E. CONTRACT/PR NO. F.CONTRACTOR

Ethyl Cellulose Hardware TBD NIA

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

A003 Certificate of Compliance Certificate of Compliance (CoC)

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-QCIC-81356A SOWPara 3.2.3, 4.0 NSWC IHD

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

LT

REQUIRED

OTIME See Blk 16 b. COPIES

8. APP CODE D (See Blk 16) 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final SUBMISSION Draft A NIA NIA Reg Repro

16. REMARKS See Blk 16 1 1 0

BLK 4: Contractor format acceptable.

BLK 9: DISTRIBUTION STATEMENT D: Distribution authorized to the Department of Defense and U.S. DoD contractors only (Administrative or Operational Use. To protect technical or operational data or information from automatic dissemination under the international exchange program or by other means. This protection covers publications required solely for official use or strictly for administrative or operational purposes. This statement may be applied to manuals, pamphlets, technical orders, technical reports, and other publications containing valuable technical or operational data.) (10/712020). Other requests shall be referred to Commanding Officer or Technical Director, NSWC Indian Head Division.

DESTRUCTION NOTICE: This document may be destroyed by any means that will prevent disclosure of contents or reconstruction of the document.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979 (Title 50, U.S.C., App 2401 et seq.), as amended.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions ofDoD Directive 5230.25.

BLK 10: Certificate of Compliance is due simultaneous with delivery of production units. Government has 15 working days from receipt of draft to review and comment. The Contractor has 10 working days from receipt of Government comments to submit revisions. If the Government does not submit revision request within 15 working days, draft submittal is approved.

BLK 14: Submit via e-mail in Microsoft Office or PDF format to the e-mail recipients listed below.

DISTRIBUTION ADDRESSEE -

Naval Surface Warfare Center Indian Head Division 4895 McMahon Rd.

Bldg. 526 Indian Head, Md 20640

POC: Francis Cooper, Ml2FC Email: francis.s.cooper@navy.mil Phone: (301)744-5527

15.TOTAL - 1 1 0 -

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

ZALEWSKI.NICHOL Digitally signed by

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AS. R.1503678868

ZALEWSKI.NICHOLAS.R.1503678868

ARIE.1459148856

56 Date: 2021.04.21 15:31:02-04'00' Date: 2021.04.21 16:35:25 -04'00'

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of 2 Pages

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE