Attachment 10 - CDRLs.pdf

CONTRACT DATA REQUIREMENT LIST

(CDRL)

CIVIL ENGINEER FACILITY AND EQUIPMENT

SUPPORT FOR INTELLIGENCE AND RESEARCH AND

DEVELOPMENT ACTIVITIES

ATTACHMENT 10

FA8601-XX-X-XXXX

WRIGHT-PATTERSON AIR FORCE BASE, OHIO

2 December 2021

CONTRACT DATA REQUIREMENTS LIST (CDRL)

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. in Block E.

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

0001 A TDP ____ TM _______ OTHER_N/A REF: DOD 5010.12-M ___

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

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

COMMERCIAL OFF THE SHELF (COTS) MANUAL AND MANUALS / WARRANTIES

A001 ASSOCIATED SUPPLEMENTAL DATA

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-TMSS-80527B/T PWS, Para. 2.6 88 AFLCMC/PZIO TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED ASREQ * b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * ** draft reg repr

16. REMARKS 88 ABW/CEOES 1

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically to CE Support Contract sharepoint site and LabWR application. Microsoft Office or Adobe Acrobat compatible format required.

88 ABW/CEOES

ASREQ means as required to document purchasing plan throughout this effort.

* Equipment Installation.

** 30 days after Block 11 time.

Block 9: B: Distribution authorized to US Government agencies only.

Prior to purchasing any new equipment item exceeding $10,000.00 or as requested by the CO, the contractor shall submit for approval to the CO, the manufacturer’s current technical data (e.g., catalog cuts or brochures). All submittals required by paragraph 8.1, Environmental Requirements, shall be submitted to the CO for approval. All Operation & Maintenance (O&M) Manuals, wiring diagrams and warranty information shall be submitted to the CO for approval. A properly documented AF Form 3000 shall accompany all submittals. The submittal packages shall be submitted electronically to the SharePoint site for approval. An associated email shall be sent to the Civil Engineering COR (CE COR) and each CE COR for notification purposes. One hard copy of O&M Manuals, wiring diagrams and warranty information shall also be submitted. The contractor shall maintain and make available to the government as requested a record of all submittals. (Attachment 10, Data Item No. A001)

LAB WR 1

15. TOTAL - - - - - - - - -> 2

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

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

SCIENTIFIC & TECHNICAL REPORTS SAFETY & HEALTH PLAN

A002

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-MISC-80711A/T PWS, Para. 8.3 88 AFLCMC/PZIO TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED ASREQ * b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * R/ASR draft reg repr

16. REMARKS 88 AFLCMC/PZIO 1

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically via e-mail to CO and CEPCOR Report shall be Microsoft Office or Adobe Acrobat compatible format.

ASREQ means as required to document safety & health plan throughout this effort.

Submit as generated.

* - No later than 10 days after contract award

R/ASR means revisions as required to keep the Safety Plan up to date, make changes or corrections, submit revisions as generated.

Block 9: B: Distribution authorized to US Government agencies only.

IAW Attachment 10, Data Item A002. The contractor’s plan shall include appropriate measures to ensure the contractor reacts promptly to investigate, correct, and track alleged safety and health violations and/or uncontrolled hazards in contractor work areas. The plan shall:

Demonstrate a management commitment to employee safety and health;

Identify the application of the safety and health plan to subcontractors;

Identify the roles and responsibilities of the following individuals with respect to safety and VPP:

Management, Supervisors, Employees, and Safety Coordinator;

Identify applicable safety rules and regulations;

Include a worksite hazard analysis to include base-line hazard identification and required control measures;

Include a job site analysis to include hazards of tasks required to control measures;

Identify employee safety and health training requirements and the documentation process;

Include a workplace inspection frequency, to include identifying the individual conducting the inspections;

Include employee hazard reporting procedures;

Identify individual(s) responsible for corrective action of hazards;

Identify first aid/injury procedures;

Identify procedures for accident investigation and reporting;

Identify emergency response procedures; and

Identify the process for tracking controlled hazards in contractor work areas.

88ABW/CEOES 1

15. TOTAL - - - - - - - - -> 2

I. APPROVED BY G. PREPARED BY H. DATE

J. DATE

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 2 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

SCIENTIFIC & TECHNICAL REPORTS SAFETY & HEALTH PLAN

A003 TCIR REPORT

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-MISC-80711A/T PWS, Paras. 8.3 88 AFLCMC/PZIO TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED ANNUALLY 15 JANUARY b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A 15 JANUARY draft reg repr

16. REMARKS 88 AFLCMC/PZIO 1

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically via e-mail to CO and CEPCOR

Submit as generated.

Block 9: B: Distribution authorized to US Government agencies only.

The contractor shall submit their Total Case Incidence Rate (TCIR) and Days Away, Restricted, and or Transfer Case Incident Rate (DART) rates and OSHA Form 300A, Summary of Work Related Injuries and Illnesses, annually to the CEPCOR for consolidation and submission as part of the installation’s annual VPP Safety and Health Management report. TCIR and DART rates are due by the 15th of January of each year IAW Attachment 10, Data Item A003.

88ABW/CEOES 1

15. TOTAL - - - - - - - - -> 2

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 3 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

MONTHLY STATUS REPORT MAINTENANCE/REPAIR/REPLACEMENT

A004

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-FNCL-80331A/T PWS, Para. 4.1.3, 5.1.2 88 ABW/CEOES TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED MONTHLY * b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * ** draft reg repr

16. REMARKS 88 ABW/CEOES 1

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically to CE Support Contract Sharepoint Site. Microsoft Office or Adober Acrobat compatible format required.

* 45 days after contract award, ** Every month after Block 12

Block 9: B: Distribution authorized to US Government agencies only.

Monthly Status Report. The contractor shall provide a status report for all customers on a Microsoft Office 2013 Excel spreadsheet and/or Word document IAW Attchment 10, Data Item No. A004. Funds shall be segregated by customer (i.e. Lab) by individual tabs on the spreadsheet.

Show funds loaded, invoiced, outstanding and available balance for Labor, Overtime and Materials

Summary of Accomplishments for the month

Major Issues/Concerns and recommended solutions

Contractor personnel assigned / vacancies

Summarize any projected funds shortages

Profile of manpower usage

Document Contractor QC Inspections

15. TOTAL - - - - - - - - -> 1

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 4 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

SCIENTIFIC & TECHNICAL REPORTS INVENTORY / SERVICE REPORT

A005 MAINTENANCE/REPAIR/REPLACEMENT

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-MISC-80711A/T PWS, Para. 3.6.1, 3.6.2 88 ABW/CEOES TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED MONTHLY * b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * ** draft reg repr

16. REMARKS 88 ABW/CEOES 1

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically to CE Support Contract Site or LabWR application. Microsoft Offce or Adobe Acrobat compatible format required.

* Submit 10 days after the start of the contract and completion of the joint inventory.

** Submit 10 days after the end of each month.

Block 9: B: Distribution authorized to US Government agencies only.

The contractor shall provide an accurate and current report for the refrigerant inventory provided to the contractor for use on this contract. The inventory report shall include the description of item, quantity, and location. The report shall document any item used, the date the item was used, and the EIN of the equipment the item was used on. The inventory report shall also account for refrigerant purchased but not completely used. The residual refrigerant shall be added to the inventory and tracked.

The contractor shall provide accurate Service Reports that describe the contractors response to a refrigerant leak and its corrective action.

Inventory / Service Report IAW Attachment 10, Data Item No. A005.

15. TOTAL - - - - - - - - -> 1

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 5 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

MAINTENANCE/REPAIR/REPLACEMENT

A006

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-FNCL-80331A/T PWS, Para. 3.3.21 88 ABW/CEOES TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED ANNUAL * b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * * draft reg repr

16. REMARKS 88 ABW/CEOES 1

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically to CE Support Contract sharepoint site. Microsoft Office compatible format required.

* Submit NLT 10 days after the end of each month.

Block 9: B: Distribution authorized to US Government agencies only.

Cranes & Hoists. As part of the preventive maintenance program, the contractor shall perform Annual preventive maintenance (PM) inspections and provide reliable and continuous safe operation of all cranes/ hoists specified in the equipment list. Inspection tags on the hoists/ cranes shall be updated by the contractor with current tags. The work shall be in accordance with commercial practices, and any federal, state and local regulations, specifically: American National Standards Institute (ANSI) Standards – ANSI B30 series for Cranes and Other Lifting and Material Handling Related Equipment; Air Force Occupational Safety and Health Standard (AFOSH) 91-46, Materials Handling and Storage Equipment; AFOSH 91-10, Civil Engineering (reference Paragraph 2.10, Hoists and Cranes); and American Society of Mechanical Engineers (ASME) B30.11-2004, Monorails and Underhung Cranes. The contractor shall also upload to the SharePoint a crane & hoist database at the end of each month. The updating shall require the contractor to annotate all cranes & hoists checked, specify any repairs needed and upload a copy of the certification of safety inspection if completed. The crane & hoist database shall be on a website provided by the government and include a log of existing crane & hoists. The database may increase or decrease in quantity throughout the life of the contract in relation to equipment list changes. Reference Attachment 10, CDRL A006 – Crane & Hoist Survey.

15. TOTAL - - - - - - - - -> 1

I. APPROVED BY G. PREPARED BY H. DATE

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 6 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

SCIENTIFIC & TECHNICAL REPORTS WATER TREATMENT PROFESSIONAL/ STRATEGY

A007 MAINTENANCE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-MISC-80711A/T PWS, Para. 3.3.12 88 ABW/CEOES TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED ONCE * b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * ** draft reg repr

16. REMARKS 88 ABW/CEOES 1

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically to CE Support Contract Site. Microsoft Offce or Adobe Acrobat compatible format required.

* Within 30 calendar days of contract award

** Revise if Water Treatment Professional changes

Block 9: B: Distribution authorized to US Government agencies only.

Water Treatment Professional / Strategy Report: Per Attachment 10, CDRL A007 - Provide water treatment professional credentials. Water treatment professional shall determine appropriate control ranges and test cycles to properly treat industrial water systems. The contractor shall inspect all existing water treatment systems and shall propose water treatment strategy in a report for each system identified in the government furnished equipment list. Revise if Water Treatment Professional changes.

15. TOTAL - - - - - - - - -> 1

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 7 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

SCIENTIFIC & TECHNICAL REPORTS

A008

3. SUBTITLE

WATER TREATMENT

DEFICIENCY REPORTS

MAINTENANCE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-MISC-80711A/T PWS, Para. 3.3.12 - 3.3.19 88 ABW/CEOES TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED ONCE * b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * draft reg repr

16. REMARKS 88 ABW/CEOES 1

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically to CE Support Contract Site. Microsoft Office or Adobe Acrobat compatible format required.

* 30 calendar days after contract award

Block 9: B: Distribution authorized to US Government agencies only.

Water Treatment Tests and Reports: Per Attachment 10, CDRL A008 - Performed by the Water Treatment Professional.

Inspect all existing Open Loop equipment identified on the equipment list for proper operation and provide a report listing any deficiencies found.

Inspect all existing Closed Loop equipment identified on the equipment list for proper operation and provide a report listing any deficiencies found.

Inspect all existing Boiler Systems equipment identified on the equipment list for proper operation and provide a report listing any deficiencies found.

Inspect all existing Lab Equipment Systems identified on the equipment list for proper operation and provide a report listing any deficiencies found.

15. TOTAL - - - - - - - - -> 1

I. APPROVED BY G. PREPARED BY H. DATE

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 8 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

SCIENTIFIC & TECHNICAL REPORTS

A009

3. SUBTITLE

WATER TREATMENT MONTHLY

REPORTS

MAINTENANCE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-MISC-80711A/T PWS, Para. 3.3.12 - 3.3.19 88 ABW/CEOES TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED MONTHLY * b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * ** draft reg repr

16. REMARKS 88 ABW/CEOES 1

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically to CE Support Contract Site or LabWR application. Microsoft Office or Adobe Acrobat compatible format required.

* Five days after the first month.

** Submit 5 business days after end of each month for the life of the contract.

Block 9: B: Distribution authorized to US Government agencies only.

Water Treatment Tests and Reports: Per Attachment 10, CDRL A009, Water treatment professional shall test and report on the following systems on a monthly basis.

Open loop tests and reports shall include, at a minimum: pH, conductivity, hardness (total), hardness (calcium), alkalinity M, TDS, LSI, average makeup (gallons per day) and problems identified.

Closed loop tests and reports shall include, at a minimum: pH, conductivity, nitrite, iron, copper, glycol composition (if applicable) and problems identified.

Boiler systems tests and reports shall include, at a minimum: pH, conductivity, nitrite, iron, copper and problems identified.

Lab equipment systems tests and report requirements shall be developed by Lab SME or CE COR and water treatment professional recommendations.

Water Treatment Tests and Reports: Water Treatment Professional shall test and report corrosion coupons as required:

Corrosion coupons shall be installed, tested, and reported in accordance with ASTM Standard No. D2688-05, "Standard Test Methods for Corrosivity of Water in the Absence of Heat Transfer (Weight Loss Methods)".

15. TOTAL - - - - - - - - -> 1

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 9 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

SCIENTIFIC & TECHNICAL REPORTS PERSONNEL REQUIREMENTS

A010 MAINTENANCE/REPAIR/REPLACEMENT

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-MISC-80711A/T PWS Para 3.9, 6.4, Appendix I AFLCMC/PZIO TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED ONE/R ** b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * R/ASREQ draft reg repr

AFLCMC/PZIO 1

88 ABW/CEOES

16. REMARKS

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically by email to CEPCOR and AFLCMC/PZIO. Microsoft Office or Adobe Acrobat compatible format required.

ONE/R means once unless revisions are required.

* Contract start date.

** Submit 5 days prior to contract start date.

R/ASREQ means revisions as required to keep up to date or incorporate revisions.

Block 9: B: Distribution authorized to US Government agencies only.

The contractor shall submit in writing to the COR an annual listing of their ICS personnel designated as Technical Expert for every ICS system responsible for servicing under this PWS. A Technical Expert must be designated and available to assist during IA Validators during ICS Risk Assessments, Reevaluation of Certification & Accreditation Packages, and System Identification Profile (SIP) development (see para. 6.4).

The ICS Technical Expert reporting shall be IAW Attachment 10, CDRL No. A010

The contractor shall have qualified and trained personnel for the skills and duties required for this contract.

Any contractor personnel performing Industrial Controls Technician duties on this contract shall possess training certificates IAW Appendix I, "Position Descriptions and Minimum Qualifications". A copy of each individual's certification shall be submitted IAW Appendix A, CDRL A010.

Any contractor personnel performing welding duties on this contract shall possess credentials per Appendix I, "Position Descriptions and Minimum Qualifications". Submit certification IAW Attachment 10, CDRL No. A010

Any contractor personnel performing electrician duties on this contract shall possess electrician credentials IAW Appendix I, "Position Descriptions and Minimum Qualifications". Submit credentials IAW Attachment 10, CDRL No. A010

Any contractor personnel performing Chiller Technician duties on this contract shall possess chiller training certificates IAW Appendix I, "Position Descriptions and Minimum Qualifications". A copy of each individual's certificates shall be submitted IAW Attachment 10, CDRL No. A010.

Any contractor personnel performing HVAC Technician duties on this contract shall possess documentation of the successful completion of a registered apprenticeship program for HVAC IAW Appendix I, "Position Descriptions and Minimum Qualifications". A copy of each individuals documentation shall be submitted IAW Attachment 10, CDRL No. A010.

Any contractor personnel performing as a chiller, air conditioning or refrigeration technician on this contract shall be certified "Universal" IAW Environmental Protection Agency (EPA) under Section 608 of the Clean Air Act (CAA). Submit certification IAW Attachment 10, CDRL No. A010.

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 10 of 11 Pages

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send

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

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

SCIENTIFIC & TECHNICAL REPORTS QUALITY CONTROL PLAN

A011 MAINTENANCE/REPAIR/REPLACEMENT

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED DI-MISC-80711A/T PWS, Para.5.1.1. AFLCMC/PZIO TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION LT REQUIRED ONE/R ** b. COPIES

8. APP CODE B 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM. a. ADDRESSEE final N/A * R/ASREQ draft reg repr

AFLCMC/PZIO 1 16. REMARKS

Tailored to allow contractor's format. Do not submit to DTIC.

Submit electronically to CE Support Contract Site and paper copy to AFLCMC/PZIO. Microsoft Office or Adobe Acrobat compatible format required.

ONE/R means once unless revisions are required.

* Contract start date.

** Submit 5 days prior to contract start date.

R/ASREQ means revisions as required to keep the Quality Control Plan up to date or incorporate revisions.

Block 9: B: Distribution authorized to US Government agencies only.

The contractor shall establish and maintain a Quality Control Plan to ensure requirements of the contract are provided. The Quality Control Plan is subject to non-acceptance by the CO and revision required by the contractor at no additional cost to the government to ensure quality service. Contractor compliance with the Quality Control Plan will be monitored by the government. The Quality Control Plan shall demonstrate how the contractor will maintain an inspection system to document processes and procedures to monitor and control objectives in the Services Summary to include Quality Workmanship, Timely Data Entry, Subcontractor Relationships, Contractor and subcontractor invoicing, Non-conformances, Contractor employee qualifications and certifications, government issued key and / or combination control . Revision required with employee turnover or changes to contractor processes. Submit IAW Attachment 10, Data Item No. A011.

88 ABW/CEOES 1

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 11 of 11 Pages