Attachment D2 - 5280ZN02 DD 1423 CDRL Form Certification.pdf

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Attached to
Special Containers Federal contract opportunity
Solicitation number
N4215826QE002
Issued by
Department of the Navy Naval Sea Systems Command

About this file

This document is a Contract Data Requirements List (CDRL) for a U.S. Department of Defense contract. The specific data item (A001) is a Certification for a container that meets the requirements of 49 CFR 173.24 and 49 CFR 173.410. The contract number is N42158-5280ZN02, with the requiring office being NNSY C2305 (Norfolk Naval Shipyard). The distribution statement limits access to U.S. DOD contractors, with a focus on critical technology, and requires signed certifications to be furnished with material and packaged inside a shipping container. The document is dated 10/7/2025 and was prepared by David M. Love, with the contract to be referenced at the Norfolk Naval Shipyard in Portsmouth, VA.

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CONTRACT DATA REQUIREMENTS LIST (CDRL)

(1 Data Item) 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 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 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

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

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL ▬▬▬▬►

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

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

A CONTRACT LINE ITEM NO: TBD
B EXHIBIT: A
D SYSTEMITEM:
E CONTRACTPR NO: N42158-5280ZN02
F CONTRACTOR: TBD
1 DATA ITEM NO: A001
2 TITLE OF DATA ITEM: CERTIFICATION
3 SUBTITLE: CONTAINER MEETS THE REQUIREMENTS OF 49 CFR 173.24 AND 49 CFR 173.410
17 PRICE GROUP:
4 AUTHORITY Data Acquisition Document No: DI-NDTI-80809
5 CONTRACT REFERENCE: Per Contract-Attachment (A2)
6 REQUIRING OFFICE: NNSY C2305
7 DD 250 REQ: LT
8 APP CODE: N/A
9 DIST STATEMENT REQUIRED: D
10 FREQUENCY: ASREQ*
12 DATE OF FIRST SUBMISSION: SEE BLK 16
11 AS OF DATE: N/A
H DATE: 10/7/2025
a ADDRESSEE16 REMARKS: Norfolk Naval Shipyard
Draft16 REMARKS:
Reg16 REMARKS: 1
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a ADDRESSEE16 REMARKS_2: Bldg-276
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a ADDRESSEE16 REMARKS_3: Portsmouth, VA 23709-5000
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a ADDRESSEE16 REMARKS_4: Attn: 5280ZN02
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Pages:
Page: 1
2025-10-07T11:49:24-0400
LOVE.DAVID.M.1229663867
13 DATE IF SUBSEQUENT SUBM: SEE BLK 16
Remarks: BLK 9:

DISTRIBUTION STATEMENT D DISTRIBUTION AUTHORIZED TO THE DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY (CRITICAL TECHNOLOGY) (27 MAY 2024). OTHER REQUESTS SHALL BE REFERRED TO POC AT NORFOLK NAVAL SHIPYARD, PORTSMOUTH, VA. 23709-5000

BLK 10, 12, 13 & 14:

SIGNED CERTIFICATIONS ARE REQUIRED PER ATTACHMENT (A), ITEM 2.2 OF THIS CONTRACT.

REPORT(S) SHALL BE FURNISHED WITH MATERIAL, PACKAGED INSIDE SHIPPING CONTAINER.

C CATEGORY TDP TM OTHER: NDTI
TM:
TDP:

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