Attach 19b Section 11A Operations and Maintenance 08 Dec 2021.pdf

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DD FORM 1423, AUG 96

CONTRACT DATA REQUIREMENTS LIST

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The 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 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:

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

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.

DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15. 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.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

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 (BACK), AUG 96

addr1_1: HHQ via COR draft1_1:

reg1_1:

repro1_1:

addr1_2:

draft1_2:

reg1_2:

repro1_2:

addr1_3:

draft1_3:

reg1_3:

repro1_3:

draft2_1:

addr2_1: HHQ via COR addr2_2:

reg2_1:

repro2_1:

addr2_3:

draft2_3:

reg2_3:

repro2_3:

addr3_1:

addr3_2:

addr3_3:

draft3_1:

reg3_1:

repro3_1:

draft3_2:

reg3_2:

repro3_2:

draft3_3:

reg3_3:

repro3_3:

addr4_1: HHQ via COR draft4_1:

reg4_1:

repro4_1:

addr4_2:

draft4_2:

reg4_2:

repro4_2:

addr4_3:

draft4_3:

reg4_3:

repro4_3:

draft2_2:

repro2_2:

reg2_2:

line_item: CLIN X007 exhibit:

xtdp: Off xtm: Off othercat: PWS system: Base Operations Support (BOS) Laughlin ctr_no:

contr:

data_item1: 1125 title1: Airfield Pavement Sustainment Plan sub1:

auth1:

ref1: PWS 11.1.2.2.2; 11.1.2.2.2.1.1.

req_ofc1: 47 CONS/PKB dd250_1: LT appcode1: A dist1: D freq1: ANNLY asof1: N/A firstsub1: After Award subsub1: Per PWS group1:

totalprice1:

rmks1: Send Government approved Plan totaldraft1: 0 totalreq1: 0 totalrepro1: 0 data_item2: 1126 title2: Aircraft Arresting Report sub2:

auth2:

ref2: PWS 11.1.2.5.2.1.

req_ofc2: 47 CONS/PKB dd250_2: LT appcode2: A dist2: D freq2: ASREQ asof2: N/A firstsub2: After Award subsub2: Per PWS rmks2: Submit Aircraft Engagement Information and all Missed Engagement Attempts as soon as possible after Engagement or Missed Engagement.

group2:

totalprice2:

totaldraft2: 0 totalreg2: 0 totalrepro2: 0 data_item3: 1127 title3: Aircraft Arresting System (AAS) Certification sub3: AF Form 483 auth3:

ref3: PWS 11.1.2.5.2.1.

req_ofc3: 47 CONS/PKB dd250_3: N/A appcode3: A dist3: D freq3: ANNLY asof3: N/A firstsub3: After Award subsub3: Per PWS rmks3: Certificate of Competency for all Non-Power Production Personnel Engaged in Daily Aircraft Arresting System Activities. Keep Locally in Each Personnel’s Training Records.

group3:

totalprice3:

totaldraft3: 0 totalreg3: 0 totalrepro3: 0 data_item4: 1128 title4: Call for CEMIRT Requirements sub4:

auth4:

ref4: PWS 11.1.2.2.

req_ofc4: 47 CONS/PKB dd250_4: LT appcode4: A dist4: D freq4: MTHLY asof4: N/A firstsub4: After Award subsub4: Per PWS rmks4: Identify Requirement for HVAC Re-commissioning, Generator Rebuilds, etc.; IAW HHQ.

group4:

totalprice4:

totaldraft4: 0 totalreg4: 0 totalrepro4: 0 prep_by:

prep_date:

app_by:

app_date:

Page: 7 pages:

app: Adobe Professional 8.0

Reset:

The 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 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

Item 4; Clarification of submittal dates in Items 12 and 13;

conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any addr1_1: HHQ via COR draft1_1:

reg1_1:

repro1_1:

addr1_2:

draft1_2:

reg1_2:

repro1_2:

addr1_3:

draft1_3:

reg1_3:

repro1_3:

draft2_1:

addr2_1: HHQ via COR addr2_2:

reg2_1:

repro2_1:

addr2_3:

draft2_3:

reg2_3:

repro2_3:

addr3_1: HHQ via COR addr3_2:

addr3_3:

draft3_1:

reg3_1:

repro3_1:

draft3_2:

reg3_2:

repro3_2:

draft3_3:

reg3_3:

repro3_3:

addr4_1:

draft4_1:

reg4_1:

repro4_1:

addr4_2:

draft4_2:

reg4_2:

repro4_2:

addr4_3:

draft4_3:

reg4_3:

repro4_3:

draft2_2:

repro2_2:

reg2_2:

line_item: CLIN X007 exhibit:

xtdp: Off xtm: Off othercat: PWS system: Base Operations Support (BOS) Laughlin ctr_no:

contr:

data_item1: 1129 title1: Status of Corrective Actions Identified by CEMIRT HVA sub1:

auth1:

ref1: PWS 11.1.2.4.8.2.

req_ofc1: 47 CONS/PKB dd250_1: LT appcode1: A dist1: D freq1: MTHLY asof1: N/A firstsub1: After Award subsub1: Per PWS group1:

totalprice1:

rmks1: Justify Expense of CEMIRT Activity, IAW HHQ Call Letter.

totaldraft1: 0 totalreq1: 0 totalrepro1: 0 data_item2: 1130 title2: Quarterly HVAC Refrigerant Report sub2:

auth2:

ref2: PWS 11.1.2.4.8.

req_ofc2: 47 CONS/PKB dd250_2: LT appcode2: A dist2: D freq2: MTHLY asof2: N/A firstsub2: After Award subsub2: Per PWS rmks2: AFPIMS Report Indicating Refrigerant Consumptions/Usage/ Equipment Leakage for All Equipment.

group2:

totalprice2:

totaldraft2: 0 totalreg2: 0 totalrepro2: 0 data_item3: 1131 title3: Annual Gas Survey Report sub3:

auth3:

ref3: PWS 11.1.2.4.3.

req_ofc3: 47 CONS/PKB dd250_3: N/A appcode3: A dist3: D freq3: ANNLY asof3: N/A firstsub3: After Award subsub3: Per PWS rmks3: Developed Identifying/Indicating Status of Natural Gas Distribution Systems; IAW AFI 32-1067, US Dept. of Trans; PHMSA. Submit Annually (Each January for the Previous Business Yr).

group3:

totalprice3:

totaldraft3: 0 totalreg3: 0 totalrepro3: 0 data_item4:

title4:

sub4:

auth4:

ref4:

req_ofc4:

dd250_4:

appcode4:

dist4:

freq4:

asof4:

firstsub4:

subsub4:

rmks4:

group4:

totalprice4:

totaldraft4: 0 totalreg4: 0 totalrepro4: 0 prep_by:

prep_date:

app_by:

app_date:

Page: 8 pages:

app: Adobe Professional 8.0

Reset:

The 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 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

Item 4; Clarification of submittal dates in Items 12 and 13;

conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any addr1_1: COR draft1_1:

reg1_1:

repro1_1:

addr1_2:

draft1_2:

reg1_2:

repro1_2:

addr1_3:

draft1_3:

reg1_3:

repro1_3:

draft2_1:

addr2_1: COR addr2_2:

reg2_1:

repro2_1:

addr2_3:

draft2_3:

reg2_3:

repro2_3:

addr3_1: COR addr3_2:

addr3_3:

draft3_1:

reg3_1:

repro3_1:

draft3_2:

reg3_2:

repro3_2:

draft3_3:

reg3_3:

repro3_3:

addr4_1: COR draft4_1:

reg4_1:

repro4_1:

addr4_2:

draft4_2:

reg4_2:

repro4_2:

addr4_3:

draft4_3:

reg4_3:

repro4_3:

draft2_2:

repro2_2:

reg2_2:

line_item: CLIN X007 exhibit:

xtdp: Off xtm: Off othercat: PWS system: Base Operations Support (BOS) Laughlin ctr_no:

contr:

data_item1: 1133 title1: Backflow Prevention Inspection Data sub1:

auth1:

ref1: PWS 11.1.2.4.2.; 11.1.2.4.2.2.

req_ofc1: 47 CONS/PKB dd250_1: N/A appcode1: A dist1: D freq1: ASREQ asof1: N/A firstsub1: After Award subsub1: Per PWS group1:

totalprice1:

rmks1: Provide Permanent Records in a Computer Database; Electronic AF Forms 843, 845, 848 or state mandated form(s). Database Updated with Current Inspection/ Testing.

totaldraft1: 0 totalreq1: 0 totalrepro1: 0 data_item2: 1134 title2: Backflow Device and Cross- Connection Information/Inv sub2:

auth2:

ref2: PWS 11.1.2.4.2.;11.1.2.4.2.2.

req_ofc2: 47 CONS/PKB dd250_2: LT appcode2: A dist2: D freq2: ASREQ asof2: N/A firstsub2: After Award subsub2: Per PWS rmks2: Provide Consolidated Survey Inventory Data with Cross Connection Information; Records in a Computer Database; Electronic AF Forms 843, 845, 848 or state mandated form(s), Periodically.

group2:

totalprice2:

totaldraft2: 0 totalreg2: 0 totalrepro2: 0 data_item3: 1135 title3: Backflow Prevention Cross- Connection Survey sub3:

auth3:

ref3: PWS 11.1.2.4.2.2.

req_ofc3: 47 CONS/PKB dd250_3: LT appcode3: A dist3: D freq3: ASREQ asof3: N/A firstsub3: After Award subsub3: Per PWS rmks3: Accomplish a complete and full survey of all assets. All Assets Surveyed Within Contract’s 3rd Period of Performance. Afterwards Revalidate/ Reschedule All Assets within a 5 Year Span. Provide Monthly Report Indicate Facilities/Sys Surveyed.

group3:

totalprice3:

totaldraft3: 0 totalreg3: 0 totalrepro3: 0 data_item4: 1136 title4: Valve and Hydrant Maintenance Record sub4:

auth4:

ref4: PWS 11.1.2.4.2.

req_ofc4: 47 CONS/PKB dd250_4: LT appcode4: A dist4: D freq4: ASREQ asof4: N/A firstsub4: After Award subsub4: Per PWS rmks4: Facility Operating Logs (Locally Developed), Electronic Spreadsheet for Annual Report As Inspected./ Report Provided Annually group4:

totalprice4:

totaldraft4: 0 totalreg4: 0 totalrepro4: 0 prep_by:

prep_date:

app_by:

app_date:

Page: 9 pages:

app: Adobe Professional 8.0

Reset:

The 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 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

Item 4; Clarification of submittal dates in Items 12 and 13;

conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any addr1_1: Veh Ops 47 LRF draft1_1:

reg1_1:

repro1_1:

addr1_2: Lead COR draft1_2:

reg1_2:

repro1_2:

addr1_3:

draft1_3:

reg1_3:

repro1_3:

draft2_1:

addr2_1: (HHQ) via COR addr2_2:

reg2_1:

repro2_1:

addr2_3:

draft2_3:

reg2_3:

repro2_3:

addr3_1: (HHQ) via COR addr3_2:

addr3_3:

draft3_1:

reg3_1:

repro3_1:

draft3_2:

reg3_2:

repro3_2:

draft3_3:

reg3_3:

repro3_3:

addr4_1: HHQ via COR draft4_1:

reg4_1:

repro4_1:

addr4_2:

draft4_2:

reg4_2:

repro4_2:

addr4_3:

draft4_3:

reg4_3:

repro4_3:

draft2_2:

repro2_2:

reg2_2:

line_item: CLIN X007 exhibit:

xtdp: Off xtm: Off othercat: PWS system: Base Operations Support (BOS) Laughlin ctr_no:

contr:

data_item1: 1101 title1: Air Force Motor Vehicle Operator Identification Card sub1: AF Form 2293 auth1:

ref1: PWS 11.1.2.2.21.5.

req_ofc1: 47 CONS/PKB dd250_1: NA appcode1: A dist1: D freq1: ASREQ asof1: N/A firstsub1: After Award subsub1: Per PWS group1:

totalprice1:

rmks1: Submission: Prior to Driving a GOV totaldraft1: 0 totalreq1: 0 totalrepro1: 0 data_item2: 1102 title2: Self-Inspection Checklist sub2: Management Int Control Toolsets (MICT) auth2:

ref2: PWS 11.2;11.1.2.1; 11.1.2.1.3.1 req_ofc2: 47 CONS/PKB dd250_2: LT appcode2: A dist2: D freq2: ASREQ asof2: N/A firstsub2: After Award subsub2: Per PWS rmks2: IAW AFI 90-201, Submit to Higher Headquarter (HHQ) via COR IAW CCs Inspection Program.

group2:

totalprice2:

totaldraft2: 0 totalreg2: 0 totalrepro2: 0 data_item3: 1103 title3: Industrial Control System (ICS) Report sub3: Government approved spreadsheet and Schem auth3:

ref3: PWS 11.1.1;11.1.2.2.17-1 req_ofc3: 47 CONS/PKB dd250_3: LT appcode3: A dist3: D freq3: ASREQ asof3: N/A firstsub3: After Award subsub3: Per PWS rmks3: Send whenever a new system comes on line and as directed by HHQ.

group3:

totalprice3:

totaldraft3: 0 totalreg3: 0 totalrepro3: 0 data_item4: 1104 title4: Electrical System Vulnerability sub4: Government approved Spreadsheet auth4:

ref4: PWS 11.1.2.2.2 req_ofc4: 47 CONS/PKB dd250_4: LT appcode4: A dist4: D freq4: ANNLY asof4: N/A firstsub4: After Award subsub4: Per PWS rmks4: IAW UFC 3-550-07.

group4:

totalprice4:

totaldraft4: 0 totalreg4: 0 totalrepro4: 0 prep_by:

prep_date:

app_by:

app_date:

Page: 1 pages:

app: Adobe Professional 8.0

Reset:

The 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 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

Item 4; Clarification of submittal dates in Items 12 and 13;

conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any addr1_1: COR draft1_1:

reg1_1:

repro1_1:

addr1_2:

draft1_2:

reg1_2:

repro1_2:

addr1_3:

draft1_3:

reg1_3:

repro1_3:

draft2_1:

addr2_1: COR addr2_2:

reg2_1:

repro2_1:

addr2_3:

draft2_3:

reg2_3:

repro2_3:

addr3_1:

addr3_2:

addr3_3:

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draft3_2:

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addr4_1:

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repro4_2:

addr4_3:

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repro4_3:

draft2_2:

repro2_2:

reg2_2:

line_item: CLIN X007 exhibit:

xtdp: Off xtm: Off othercat: PWS system: Base Operations Support (BOS) Laughlin ctr_no:

contr:

data_item1: 1138 title1: Above Ground Storage Tank Inventory sub1:

auth1:

ref1: PWS 11.1.2.4.2; 11.1.2.4.2.5.

req_ofc1: 47 CONS/PKB dd250_1: LT appcode1: A dist1: D freq1: ANNLY asof1: N/A firstsub1: After Award subsub1: Per PWS group1:

totalprice1:

rmks1: Submit to Government approved spreadsheet.

totaldraft1: 0 totalreq1: 0 totalrepro1: 0 data_item2: 1139 title2: Swimming Pool Operational Log sub2: Electronic AF Form 708 auth2:

ref2: PWS 11.1.2.4.2; 11.1.2.4.2.4.

req_ofc2: 47 CONS/PKB dd250_2: LT appcode2: A dist2: D freq2: Daily asof2: N/A firstsub2: After Award subsub2: Per PWS rmks2: Submit Electronic AF Form 708 to Daily.

group2:

totalprice2:

totaldraft2: 0 totalreg2: 0 totalrepro2: 0 data_item3:

title3:

sub3:

auth3:

ref3:

req_ofc3:

dd250_3:

appcode3:

dist3:

freq3:

asof3:

firstsub3:

subsub3:

rmks3:

group3:

totalprice3:

totaldraft3: 0 totalreg3: 0 totalrepro3: 0 data_item4:

title4:

sub4:

auth4:

ref4:

req_ofc4:

dd250_4:

appcode4:

dist4:

freq4:

asof4:

firstsub4:

subsub4:

rmks4:

group4:

totalprice4:

totaldraft4: 0 totalreg4: 0 totalrepro4: 0 prep_by:

prep_date:

app_by:

app_date:

Page: 10 pages:

app: Adobe Professional 8.0

Reset:

The 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 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

Item 4; Clarification of submittal dates in Items 12 and 13;

conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any addr1_1: Gov.Rep/Fire Dept draft1_1:

reg1_1:

repro1_1:

addr1_2:

draft1_2:

reg1_2:

repro1_2:

addr1_3:

draft1_3:

reg1_3:

repro1_3:

draft2_1:

addr2_1: COR addr2_2:

reg2_1:

repro2_1:

addr2_3:

draft2_3:

reg2_3:

repro2_3:

addr3_1: COR addr3_2:

addr3_3:

draft3_1:

reg3_1:

repro3_1:

draft3_2:

reg3_2:

repro3_2:

draft3_3:

reg3_3:

repro3_3:

addr4_1:

draft4_1:

reg4_1:

repro4_1:

addr4_2:

draft4_2:

reg4_2:

repro4_2:

addr4_3:

draft4_3:

reg4_3:

repro4_3:

draft2_2:

repro2_2:

reg2_2:

line_item: CLIN X007 exhibit:

xtdp: Off xtm: Off othercat: PWS system: Base Operations Support (BOS) Laughlin ctr_no:

contr:

data_item1: 1142 title1: Inspection, Test and Maintenance Documentation of Fire sub1: Electronic AF Form 1459 auth1:

ref1: PWS 11.1.2.4.2.1.

req_ofc1: 47 CONS/PKB dd250_1: LT appcode1: A dist1: D freq1: ASREQ asof1: N/A firstsub1: After Award subsub1: Per PWS group1:

totalprice1:

rmks1: SP Locally Derived Inspection/Test Form; FY Annual Report (spreadsheet) Listing Equip Svcs; AFCEC’s Standardized PMTL Series per each type of Sys. Submit Inspection/ Test Form on Date Services Are Provided; Provide a FY Annual totaldraft1: 0 totalreq1: 0 totalrepro1: 0 data_item2: 1143 title2: Tank Inspection Summary sub2: AF Form 172 auth2:

ref2: PWS 11.1.2.4.4; 11.1.2.4.4.1.

req_ofc2: (NEED COR OFFICE SYMBOL) dd250_2: LT appcode2: A dist2: D freq2: MTHLY asof2: N/A firstsub2: After Award subsub2: Per PWS rmks2: Submit AF Form 172 group2:

totalprice2:

totaldraft2: 0 totalreg2: 0 totalrepro2: 0 data_item3: 1144 title3: Tank Entry Supervisor Certification sub3: AF Form 483 auth3:

ref3: PWS 11.1.2.4.4.

req_ofc3: 47 CONS/PKB dd250_3: LT appcode3: A dist3: D freq3: ASREQ asof3: N/A firstsub3: After Award subsub3: Per PWS rmks3: Submit every five years.

group3:

totalprice3:

totaldraft3: 0 totalreg3: 0 totalrepro3: 0 data_item4:

title4:

sub4:

auth4:

ref4:

req_ofc4:

dd250_4:

appcode4:

dist4:

freq4:

asof4:

firstsub4:

subsub4:

rmks4:

group4:

totalprice4:

totaldraft4: 0 totalreg4: 0 totalrepro4: 0 prep_by:

prep_date:

app_by:

app_date:

Page: 11 pages:

app: Adobe Professional 8.0

Reset:

The 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 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

Item 4; Clarification of submittal dates in Items 12 and 13;

conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any addr1_1: COR draft1_1:

reg1_1:

repro1_1:

addr1_2:

draft1_2:

reg1_2:

repro1_2:

addr1_3:

draft1_3:

reg1_3:

repro1_3:

draft2_1:

addr2_1: COR addr2_2:

reg2_1:

repro2_1:

addr2_3:

draft2_3:

reg2_3:

repro2_3:

addr3_1: COR addr3_2:

addr3_3:

draft3_1:

reg3_1:

repro3_1:

draft3_2:

reg3_2:

repro3_2:

draft3_3:

reg3_3:

repro3_3:

addr4_1: COR draft4_1:

reg4_1:

repro4_1:

addr4_2:

draft4_2:

reg4_2:

repro4_2:

addr4_3:

draft4_3:

reg4_3:

repro4_3:

draft2_2:

repro2_2:

reg2_2:

line_item: CLIN 00 exhibit:

xtdp: Off xtm: Off othercat: PWS system: Base Operations Support (BOS) Laughlin ctr_no:

contr:

data_item1: 1145 title1: Liquid Fuels Tank Cleaning Certificate of Competency sub1: AF Form 483 auth1:

ref1: PWS 11.1.2.4.4.

req_ofc1: 47 CONS/PKB dd250_1: LT appcode1: A dist1: D freq1: ASREQ asof1: N/A firstsub1: After Award subsub1: Per PWS group1:

totalprice1:

rmks1: Submit every five years.

totaldraft1: 0 totalreq1: 0 totalrepro1: 0 data_item2: 1146 title2: Leak/Failure Data Record sub2: AF Form 1687 auth2:

ref2: PWS 11.1.2.4; 11.1.2.4.3; 11.1.2.4.4.

req_ofc2: 47 CONS/PKB dd250_2: LT appcode2: A dist2: D freq2: ASREQ asof2: N/A firstsub2: After Award subsub2: Per PWS rmks2: Submit as needed.

group2:

totalprice2:

totaldraft2: 0 totalreg2: 0 totalrepro2: 0 data_item3: 1147 title3: Pest Control Report sub3: DD Form 1532 auth3:

ref3: PWS 11.1.2.4.7.

req_ofc3: 47 CONS/PKB dd250_3: LT appcode3: A dist3: D freq3: MTHLY asof3: N/A firstsub3: After Award subsub3: Per PWS rmks3:

group3:

totalprice3:

totaldraft3: 0 totalreg3: 0 totalrepro3: 0 data_item4: 1148 title4: Confined Space Entry Permit sub4: AF Form 1024 auth4:

ref4: PWS 11.1.2.1.

req_ofc4: 47 CONS/PKB dd250_4: LT appcode4: A dist4: D freq4: ASREQ asof4: N/A firstsub4: After Award subsub4: Per PWS rmks4: Submit as needed.

group4:

totalprice4:

totaldraft4: 0 totalreg4: 0 totalrepro4: 0 prep_by:

prep_date:

app_by:

app_date:

Page: 12 pages:

app: Adobe Professional 8.0

Reset:

The 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 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

Item 4; Clarification of submittal dates in Items 12 and 13;

conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any addr1_1: Lead CE COR draft1_1:

reg1_1:

repro1_1:

addr1_2:

draft1_2:

reg1_2:

repro1_2:

addr1_3:

draft1_3:

reg1_3:

repro1_3:

draft2_1:

addr2_1: Base Safety Office addr2_2: Base Civil Engineer (B reg2_1:

repro2_1:

addr2_3:

draft2_3:

reg2_3:

repro2_3:

addr3_1: Lead CE COR addr3_2:

addr3_3:

draft3_1:

reg3_1:

repro3_1:

draft3_2:

reg3_2:

repro3_2:

draft3_3:

reg3_3:

repro3_3:

addr4_1: HHQ via COR draft4_1:

reg4_1:

repro4_1:

addr4_2:

draft4_2:

reg4_2:

repro4_2:

addr4_3:

draft4_3:

reg4_3:

repro4_3:

draft2_2:

repro2_2:

reg2_2:

line_item: CLIN X007 exhibit:

xtdp: Off xtm: Off othercat: PWS system: Base Operations Support (BOS) Laughlin ctr_no:

contr:

data_item1: 1105 title1: Customer Service: Service Requests sub1: AF Form 332 auth1:

ref1: PWS 11.1.2.2.3; 11.1.2.2.3.7;

req_ofc1: 47 CONS/PKB dd250_1: LT appcode1: A dist1: D freq1: ASREQ asof1: N/A firstsub1: After Award subsub1: Per PWS group1:

totalprice1:

rmks1: Submission: upon request.

totaldraft1: 0 totalreq1: 0 totalrepro1: 0 data_item2: 1106 title2: Safety sub2: AF Form 457 auth2:

ref2: PWS 11.1.1; 11.1.2.1.

req_ofc2: 47 CONS/PKB dd250_2: LT appcode2: A dist2: D freq2: ASREQ asof2: N/A firstsub2: After Award subsub2: Per PWS rmks2: Submit whenever an Accident Occurs.

group2:

totalprice2:

totaldraft2: 0 totalreg2: 0 totalrepro2: 0 data_item3: 1107 title3: Base Civil Engineering Work Clearance Request sub3: AF Form 103 auth3:

ref3: PWS11.1.2.2.3;11.1.2.2.3.1,7 req_ofc3: 47 CONS/PKB dd250_3: LT appcode3: A dist3: D freq3: ASREQ asof3: N/A firstsub3: After Award subsub3: Per PWS rmks3: Send as required.

group3:

totalprice3:

totaldraft3: 0 totalreg3: 0 totalrepro3: 0 data_item4: 1108 title4: Monthly Steam/Boiler Plant Operating Log sub4: AF Form 1464 auth4:

ref4: PWS 11.1.2.4.8.5.

req_ofc4: 47 CONS/PKB dd250_4: LT appcode4: A dist4: D freq4: MTHLY asof4: N/A firstsub4: After Award subsub4: Per PWS rmks4:

group4:

totalprice4:

totaldraft4: 0 totalreg4: 0 totalrepro4: 0 prep_by:

prep_date:

app_by:

app_date:

Page: 2 pages:

app: Adobe Professional 8.0

Reset:

The 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 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

Item 4; Clarification of submittal dates in Items 12 and 13;

conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any addr1_1: HHQ via COR draft1_1:

reg1_1:

repro1_1:

addr1_2:

draft1_2:

reg1_2:

repro1_2:

addr1_3:

draft1_3:

reg1_3:

repro1_3:

draft2_1:

addr2_1: HHQ via COR addr2_2:

reg2_1:

repro2_1:

addr2_3:

draft2_3:

reg2_3:

repro2_3:

addr3_1: HHQ via COR addr3_2:

addr3_3:

draft3_1:

reg3_1:

repro3_1:

draft3_2:

reg3_2:

repro3_2:

draft3_3:

reg3_3:

repro3_3:

addr4_1: HHQ via COR draft4_1:

reg4_1:

repro4_1:

addr4_2:

draft4_2:

reg4_2:

repro4_2:

addr4_3:

draft4_3:

reg4_3:

repro4_3:

draft2_2:

repro2_2:

reg2_2:

line_item: CLIN X007 exhibit:

xtdp: Off xtm: Off othercat: PWS system: Base Operations Support (BOS) Laughlin ctr_no:

contr:

data_item1: 1109 title1: Boiler or Pressure Vessel Inspection Report sub1: AF Form 1222 auth1:

ref1: PWS 11.1.2.4.8.5.

req_ofc1: 47 CONS/PKB dd250_1: LT appcode1: A dist1: D freq1: ASREQ asof1: N/A firstsub1: After Award subsub1: Per PWS group1:

totalprice1:

rmks1: Send every three years.

totaldraft1: 0 totalreq1: 0 totalrepro1: 0 data_item2: 1110 title2: Water Treatment Operating Log for Steam/Hot Water sub2: AF Form 1459 auth2:

ref2: PWS11.1.2.4.2.1; 11.1.2.4.8.5 req_ofc2: 47 CONS/PKB dd250_2: LT appcode2: A dist2: D freq2: MTHLY asof2: N/A firstsub2: After Award subsub2: Per PWS rmks2: Send monthly.

group2:

totalprice2:

totaldraft2: 0 totalreg2: 0 totalrepro2: 0 data_item3: 1111 title3: Generator Inventory sub3:

auth3:

ref3: PWS 11.1.2.5.2.

req_ofc3: 47 CONS/PKB dd250_3: LT appcode3: A dist3: D freq3: ANNLY asof3: N/A firstsub3: After Award subsub3: Per PWS rmks3: Format is government approved spreadsheet.

group3:

totalprice3:

totaldraft3: 0 totalreg3: 0 totalrepro3: 0 data_item4: 1112 title4: Generator Revalidation sub4:

auth4:

ref4: PWS 11.1.2.5.2.

req_ofc4: 47 CONS/PKB dd250_4: LT appcode4: A dist4: D freq4: ASREQ asof4: N/A firstsub4: After Award subsub4: