Attachment 5- CDRL_DID_A004.pdf

PREVIOUS EDITION MAY BE USED.

DD FORM 1423, FEB 2024 Page 1 of 2

UNCLASSIFIED

UNCLASSIFIED

CONTRACT DATA REQUIREMENTS LIST

A. CONTRACT LINE ITEM NO.

A.004

B. EXHIBIT

N/A

C. CATEGORY:

TDP TM OTHER Technical Report

D. SYSTEM/ITEM

AGM-88 HARM

E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO.

A.004

2. TITLE OF DATA ITEM

Test Report

3. SUBTITLE

N/A

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80441D

5. CONTRACT REFERENCE

PWS Paragraph 5.2

6. REQUIRING OFFICE

Tobyhanna Army Depot

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

Distribution Statement D

10. FREQUENCY

Once

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

16. REMARKS

The Contractor shall create a Test Report (A.004) and deliver the first submission to the Government after 15 days of test conclusion.

The Test Report shall include at minimum the following sections with at minimum the following:

1. Cover/ Title Page (Contractor's Business Name, Contractor's Business Address, Contractor's Business Telephone Number, date that Test Report (A.004) was prepared, and direct contact information (phone number and email address) for the primary author of the Test Procedure.

2. Table of Contents

3. List of References Documentation

4. Description - Summary of Test Report's high-level purpose and contents in <150 words

5. List of Measurement Tools & Test Equipment (include model numbers of both tools and test equipment)

6. Results of each test listed in the PWS paragraph 5.2.

Additional Requirements:

1. The Test Report shall be submitted in PDF format.

2. The Test Report shall be composed on standard letter size paper (8.5" X 11").

3. All pages of the Test Report, except the Cover/ Title Page, shall be numbered. The Title/ Cover Page shall be page 1. The page numbers shall be centrally located in the footer of each page. The page number format shall be "PAGE X OF Y" with X denoting the current page and Y denoting the total number of pages comprising the Test Report.

Other Notes:

1. The type, style, and size of font for all content comprising the Test Report shall be at the discretion of the Contractor.

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

G. PREPARED BY

Matthew Check

H. SIGNATURE I. APPROVED BY

Kyle Lovett

J. SIGNED ON 20250417

CHECK.MATTHEW.

DAVID.1369821349

Digitally signed by

CHECK.MATTHEW.DAVID.1369821

Date: 2025.04.17 10:40:19 -04'00'

LOVETT.KYLE.J

OHN.1511730160

Digitally signed by

LOVETT.KYLE.JOHN.1511730160

Date: 2025.04.17 11:33:09 -04'00'

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoDM 5010.12 for detailed instructions.)

DD FORM 1423, FEB 2024 Page 2 of 2

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 (e.g., Mission Design Series (MDS) designator).

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

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

Item G. Name of preparer of CDRL.

Item H. Date CDRL was prepared and signature of preparer of CDRL.

Item I. Name of CDRL approval authority.

Item J. Date CDRL was approved and signature of CDRL approval authority.

Item 1. See DFARS Subpart 204.71 for proper numbering. To add or delete additional data items, point and click the plus or minus sign to the right of Block J.

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. Identify only one Data Acquisition Document No. If a single work task generates more than one deliverable data product, prepare a separate data item for each deliverable data product.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work/Performance Work Statement 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 and computer software, specify the contractor's requirement to mark the appropriate distribution statement on the technical data or computer software (ref. DoDI 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.

Identify for which data item additional remarks are provided. When tailoring the Data Acquisition Document invoked in Item 4, identify which portions of that Document are being tailored.

Identify any referenced attachments to the form. Attachments can be added using the button at the bottom of page 1.

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 administrative and other expenses related to reproducing and delivering such data item to the Government.

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 rights to use the data shall be governed by the pertinent provisions of the contract.

DATA ITEM DESCRIPTION

Title: Test Report A.004

Number: DI-MGMT-80441D Approval Date:

AMSC Number: Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: Project Number:

Applicable Forms: None

Use/Relationship: The Test Report describes the contractor’s testing activities, results, findings, and test cycles.

This DID contains the format, content, and intended use information for the data deliverable resulting from the work task described in the solicitation.

This DID may be applied in any contract or program phase where the contract management is under the direction and control of the contractor.

Requirements:

1. Reference documents. None.

2. Format. The report shall be in an electronic, PDF compatible format.

3. Content. The report shall contain the following column headers (i.e., data fields):

A. Cover/ Title Page (Contractor's Business Name, Contractor's Business Address, Contractor's Business Telephone Number, date that Test Report (A.004) was prepared, and direct contact information (phone number and email address) for the primary author of the Test Procedure.

B. Table of Contents

C. List of References Documentation

D. Description - Summary of Test Procedure's high-level purpose and contents

E. List of Measurement Tools & Test Equipment (include model numbers of both tools and test equipment)

F. Numbered step-by-step procedures required to complete testing in PWS paragraph 5.2.

END OF DOCUMENT