C04.0 CDRLs & DIDs.pdf

For the best experience, open this PDF portfolio in

Acrobat X or Adobe Reader X, or later.

Get Adobe Reader Now!

http://www.adobe.com/go/reader

DATA ITEM DESCRIPTION

Title: QUALTIY MANAGEMENT SYSTEM (QMS)

Number: DI-MGMT-82184 Approval Date: 20180418

AMSC Number: N9901 Limitation: N/A

DTIC Applicable: N/A GIDEP Applicable: N/A

Preparing Activity: SH Project Number: MGMT-2018-014

Applicable Forms: N/A

Use/Relationship: The Quality Management System (QMS) provides the roadmap for the complete QMS to be implemented.

This data item description (DID) contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

Requirements:

1. Format. The QMS shall be in contractor’s format.

2. Content. The QMS shall contain the following the parts:

2.1 Subpart 1. CTTR QMS Quality Manual. This part shall include a QMS Quality Manual that is based on the existing QMS Manual and is in accordance with ISO 9001:2015. It shall also contain the following:

a. A description of the QMS

b. Proposed changes

c. Revisions

d. Updates and

e. Any changes than enhance the existing QMS Manual

f. History of revisions

2.2 Subpart 2. Plan of Action and Milestones (POA&M) Timetable. This part shall contain the following:

a. Details for the completion of all documents that are needed to implement the updated

QMS and proposed changes.

b. A timetable for the development and implementation of all plans, procedures, work

Instructions, Job Qualification Standards (JQSs), Tier IV, and records to be added or modified.

c. It shall also specify the following:

1. The document names, document number, site, and estimated dates of completion.

2. The timeline by quarters and the documents scheduled for development, verification, validation, and completion during each quarter.

Source: https://assist.dla.mil -- Downloaded: 2019-02-28T18:19Z Check the source to verify that this is the current version before use.

DI-MGMT-82184

3. Completion of all documents by the end of the first year of the contract.

4. Actual completion date

End of DI-MGMT-82184

Source: https://assist.dla.mil -- Downloaded: 2019-02-28T18:19Z

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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

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

16. REMARKS (Continued)

DD FORM 1423-1, FEB 2001 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 administrative and other expenses related to reproducing and

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 1423-1 (BACK), FEB 2001

data_item: A001 title: QUALTIY MANAGEMENT SYSTEM (QMS) sub: QUALTIY MANAGEMENT SYSTEM (QMS) auth: DI-MGMT-82184 ref: SOW paragraph 3.10.2 req_ofc: PSNS and IMF dd250: DD appcode: N/A dist: D freq: OTIME asof: See BLK 16 firstsub: See BLK 16 subsub: See BLK 16 addressee1: C/400 COR draft1:

reg1:

repro1:

addressee2: PSNS Code 120 SME draft2:

reg2: 1 repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks: Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of 7-8-2016). Other requests for the document shall be referred to PSNS and IMF, 1400 Farragut Ave. Bremerton WA, 98314.

Block 11,12 and 13: Submit copy of Quality Management System (QMS) with proposal of solicitation (ONE TIME).

group:

total_price:

prep_name:

line_item: CLIN 000X exhibit: A xtdp: Off xtm: Off othercat: X system: No. 1 & 2 SSMG ctr_no: N4523A-21-X-XXX contr: AMEE BAY remarksb:

Page2:

Reset:

prep_date:

app_by:

app_date:

Page:

of_pages:

app: Adobe Professional 8.0

Title: ACCEPTANCE TEST REPORT (ATR) Number: DI-QCIC-81891 Approval Date: 20130118 AMSC Number: N9313 Limitation: N/A DTIC Applicable: N/A GIDEP Applicable: N/A Office of Primary Responsibility: AS/PMA251 Applicable Forms: N/A

Use/relationship:

The ATR contains the results of the qualification tests performed by the contractor to demonstrate that the system conforms to the performance specifications, work authorization document, or contract requirements.

This Data Item Description (DID) contains format, content, and intended use information for the data product resulting from the work task described in the Statement of Work (SOW).

1. Format. Contractor’s format is acceptable.

2. Content. The ATR shall contain the following:

a. Test article identification and full description of test specimens utilized, including any deviations for the configuration specified in the applicable test plan.

b. Date and location of test or evaluation.

c. The operator who conducted the test.

d. Results obtained, including specific identification and discussion of objectives demonstrated satisfactorily and those not demonstrated satisfactorily.

e. Contractor’s conclusions, corrective action anticipated, recommendation to correct. deficiencies, and suggested improvements based on evaluation of the test.

f. All analysis and supporting data.

g. All data sheets.

3. End of DI-QCIC-81891.

Source: https://assist.dla.mil -- Downloaded: 2018-02-22T19:07Z

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 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 data_item: A002 title: CONTRACTOR HAZARDOUS MATERIAL INVENTORY REPORT sub: Contractor Hazardous Material Inventory Report (CHMI) auth: DI-ENVR-82091 ref: SOW paragraph 3.29.4 req_ofc: PSNS and IMF dd250: DD appcode: N/A dist: D freq: OTIME asof: See BLK 16 firstsub: ASREQ subsub: See BLK 16 addressee1: C/400 COR draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks: Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of 7-8-2016) Other requests for this document shall be referred to PSNS and IMF, 1400 Farragut Ave.

Bremerton, WA 98314.

Block 10: Submit HAZMAT Inventory to C/400 and C/106 ESH rep. with Proposal of solicitation.

Block 11, 12, and 13: Submit inventory changes within 5 days of identifying the requirement to add HAZMAT to the initial report (PER UNIT).

group:

total_price:

prep_name:

line_item: CLIN 000X exhibit: A xtdp: Off xtm: Off othercat: X system: No. 1 & 2 SSMG ctr_no: N4523A-21-X-XXX contr: AMEE BAY remarksb:

Page2:

Reset:

prep_date:

app_by:

app_date:

Page:

of_pages:

app: Adobe Professional 8.0

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 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 data_item: A003 title: Condition Found Report (CFR) sub: UNSATIFACTORY CONDITIONS, PROPOSED REPAIRS, PARTS, AND PRICING auth: DI-MGMT-81648 ref: SOW paragraph 3.10.5.1 req_ofc: PSNS and IMF dd250: LT appcode: N/A dist: D freq: ASREQ asof: See BLK 16 firstsub: ANGEN subsub: See BLK 16 addressee1: C/400 COR draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks: Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of 7-8-2016). Other requests for the document shall be referred to PSNS and IMF, 1400 Farragut Ave. Bremerton WA, 98314.

Block 11 and 13: Submit CFR for all measurements and components replaced or modified within one (1) days of completion of work (PER UNIT) .

group:

total_price:

prep_name:

line_item: CLIN 000X exhibit: A xtdp: Off xtm: Off othercat: X system: No. 1 & 2 SSMG ctr_no: N4523A-21-X-XXX contr: AMEE BAY remarksb:

Page2:

Reset:

prep_date:

app_by:

app_date:

Page:

of_pages:

app: Adobe Professional 8.0

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 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 data_item: A002 title: CONTRACTOR HAZARDOUS MATERIAL INVENTORY REPORT sub: Contractor Hazardous Material Inventory Report (CHMI) auth: DI-ENVR-82091 ref: SOW paragraph 3.10.4 req_ofc: PSNS and IMF dd250: DD appcode: N/A dist: D freq: OTIME asof: See BLK 16 firstsub: ASREQ subsub: See BLK 16 addressee1: C/400 COR draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks: Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of 7-8-2016) Other requests for this document shall be referred to PSNS and IMF, 1400 Farragut Ave.

Bremerton, WA 98314.

Block 10: Submit HAZMAT Inventory to C/400 and C/106 ESH rep. with Proposal of solicitation.

Block 11, 12, and 13: Submit inventory changes within 5 days of identifying the requirement to add HAZMAT to the initial report (PER UNIT).

group:

total_price:

prep_name:

line_item: CLIN 000X exhibit: A xtdp: Off xtm: Off othercat: X system: No. 1 & 2 SSMG ctr_no: N4523A-21-X-XXX contr: AMEE BAY remarksb:

Page2:

Reset:

prep_date:

app_by:

app_date:

Page:

of_pages:

app: Adobe Professional 8.0

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 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 data_item: A005 title: COMPLETION REPORT sub: Work Completion Certification Certificate auth: DI-MGMT-82184 ref: SOW paragraph 3.10.2 req_ofc: PSNS and IMF dd250: LT appcode: N/A dist: D freq: OTIME asof: See BLK 16 firstsub: ASREQ subsub: See BLK 16 addressee1: C/400 COR draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks: Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of 7-8-2016). Other requests for the document shall be referred to PSNS and IMF, 1400 Farragut Ave. Bremerton WA, 98314.

Block 11 and 13: Submit within 5 days of work completion (PER UNIT).

group:

total_price:

prep_name:

line_item: CLIN 000X exhibit: A xtdp: Off xtm: Off othercat: X system: No. 1 & 2 SSMG ctr_no: N4523A-21-X-XXX contr: AMEE BAY remarksb:

Page2:

Reset:

prep_date:

app_by:

app_date:

Page:

of_pages:

app: Adobe Professional 8.0

Title: CONTRACTOR HAZARDOUS MATERIAL INVENTORY REPORT

Number: DI-ENVR-82091 Approval Date: 20161208

AMSC Number: N9751 Limitation: N /A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: ENVR-2017-001

Applicable Forms: PSNS&IMF form 5090/132

Use/Relationship: Contractor Hazardous Material Inventory Report will be used to identify hazardous materials needing for approval by the government for use on the Naval Installation.

This DID contains the format and content preparation instructions for the data product generated by the discrete task requirement as delineated in the contract.

1. Format. The Hazardous Material Inventory Report shall be presented on PSNS&IMF form

5090/132 in this DID.

2. Content. The report shall contain all of the information specified in PSNS&IMF 5090/132.

End of DI-ENVR-82091

Source: https://assist.dla.mil -- Downloaded: 2018-02-22T19:11Z

DI-ENVR-82091

CONTRACTOR HAZARDOUS MATERIAL INVENTORY (CHMI)

Ref: NAVSEA Standard Items 009-97 and 009-02 NWRMC Local Standard Item 099-04NW

Document No.

CONTRACTOR – INITIAL REQUEST1 (Before moving any hazmat onto this Federal facility) **Refer to instructions on last page**

PRIME CONTRACTOR (KTR) (POC) SUB-CONTRACTOR (If Applicable) PRIME KTR CERTIFICATION SIGNATURE (sign or submit electronically) Print & sign

PHONE

Mr KTR NA Signature on File 555-232-2222

CONTRACT NUMBER PROJECT NAME2 WORKSITE LOCATION3 PROJECT EXECUTION START

DATE

PROJECTED

END5

N4523A-12-D-0003 USS Michigan Dry Dock 2 12/14/2015 04/03/2016

ENVIRONMENTAL, SAFETY, AND HEALTH (ESH) GOVERNMENT REPRESENTATIVE

CONTRACT OFFICE AGENCY (i.e., C/400, AIT)

ESH GOVERNMENT REPRESENTATIVE NAME PHONE FAX SUBMITTAL

DATE C/400/106.2 ESH SBS 360-535-2222

CODE 106.31 HAZARDOUS MATERIAL PROCESS MANAGEMENT BRANCH

106.31 NAME & INITIALS RECEIPT DATE REVIEW DATE

Trade Name6

Name on product & MSDS must match

For kits, list kit name, then list kit components individually

Manufacturer7

Name on product & MSDS must match

Process Code Number8

Use provided flow chart

Container Size & Type9

Enter size

SHIPYARD MSDS

Number10 (As assigned by Code 106.31)

SHIPYARD Assigned Stock Number (Assigned by Code 106.31)

Speclt SSPR 6PK Marking Fluorescent Green Spray Paint, #1989830

Rust-Oleum Corp. ID0507 11 oz AER See Attached SDS

CONTRACTOR HAZARDOUS MATERIAL INVENTORY (CHMI) CODE 106.31 Document No. Page 2 of 2

CONTRACTOR – INITIAL REQUEST (Before moving any hazmat onto this Federal facility)

Trade Name6

Name on product & MSDS must match

For kits, list kit name, then list kit components individually

Manufacturer7

Name on product & MSDS must match

Process Code Number8

Use provided flow chart

Container Size & Type9

Enter size

SHIPYARD MSDS Number10 (As assigned by Code 106.31)

SHIPYARD Assigned Stock

( assigned by Code 106.31)

PSNS & IMF 5090/132 (Rev. 04-13)

INSTRUCTIONS

Contractor: Fill out each section under the heading “CONTRACTOR” per the following instructions and footnotes. List all hazardous material (HM) that you, as the contractor, anticipate transporting from offsite onto the Federal property located at the Bremerton Naval Complex (BNC). Do not list HM obtained inside the BNC that has been labeled with the facility’s salmon colored supplemental barcode label. Use as many additional sheets as necessary to include all HM that you anticipate transporting onsite. Provide the most current MSDS for each product listed in the CHMI. If you are using a “Non-Road” engine do not forget to submit an O&M plan to Code 106.31 Air Department. For all marine coatings, provide a Volatile Organic Compound (VOC) certification sheet for each batch. If you have a Marine Coating that is

General Use and the VOC’s are above 340g/l you must submit separate paperwork to Code 106.31 Air department. All HM must be approved by the Code 106.31 before bringing material onsite. Low Use

Exempt materials may also be processed on this form. Upon completion of all Contractors required items submit the completed CHMI form to your Government Environmental, Safety, and Health representative.

* Prime Contractor Certification Statement: I hereby certify that the submitted information contained in the attached document(s) is true, complete and accurate, and all material listed has been approved by

Code 106.31.

Designated Government Environmental, Safety, and Health Representative: Complete Designated Government ESH section. Submit completed CHMI to Code 106.31 for review and approval.

FOOTNOTES

This is for the initial request. Use the Receipt & Monthly Usage Form to report monthly HM usage by the 5 th calendar day of the following month. Negative usage reports are required. If no usage, enter 0 in applicable field or leave blank and submit report.

Identify Project (e.g. – ship hull number or name, etc).

Identify Worksite Location (e.g. – Hull number, bldg. 431 5th floor, Dry

Dock 2, Pier D, etc).

The date that the contractor is to start work on the project.

The planned (best estimation) completion date for work on the project.

Provide a separate line for each product and/or container size that will be used. When reporting kits, list each component on separate lines. If part numbers are included in the Trade Name block, it will be helpful in processing the CHMI faster.

Reference example below.

Trade Name Manuf acturer

Container

Size & Type

MSDS

Stock

Buff Base Part

A PPG 0.8 gal CN

Converter Part

B PPG 0.2 gal CN

Welding electrodes 7018 ESAB 10lb

Table 1 – Container Type

Descripti on

Aeros ol Can

Ba g

Bottle Bo x

Cartri dge

Can Contain er

Cylind er

Drum

Code AER BG BT B

X

CA CN CO CY DR

Descripti on

Each Jar Package Ki t

Rod Spool Tank Tube

Code EA JR PG K

T

RD SP TK TU

Manufacturer, product name on container and company name must all match.

To determine the proper Process Code Number use the attached Hazardous Material Process Code Selection Flow Chart.

Report container size(s) in quantifiable units (e.g., weight or volume) such as a 3 lb. jar or a 16 fl oz bottle. For compressed gas cylinders, report the quantity of gas in cubic feet or units such as pounds (e.g., 150 cu-ft or 100 lb cylinder). For bulk material (e.g., diesel fuel) or material without a specific container size (e.g., welding rod or wire), use the units in which the material is commonly sold to consumers (e.g., use gallon for diesel fuel or pound for welding rod or wire). For kits, list both the kit size and each individual component size. Reference Footnote 6 for reporting kits. See Table 1 for the applicable container type. Enter container type code.

Provide the Shipyard approved Material Safety Data Sheet (MSDS) number (if known) or include a MSDS for each product (Code

400 projects only). Sending a Technical Data Sheet with the MSDS will be helpful in processing the CHMI faster. When sending an MSDS ensure that it is no older than 5 years old, the MSDS must be a representative of the material being used.

For Usage remember you are reporting for the size requested and it is listed on the form. When reporting round up to the nearest tenth, use percentages (i.e. do not use: 3 gal of a 10 gal container, use: .3

When Reporting Partial Usage, Use Decimals to Represent the Fraction of Container Used.

EXAMPLE:

Use 0.8 to indicate 3/4 usage of a container

Do Not Enter as Lbs, Gallons, Ounces etc.

Round Up to Nearest Tenth.

Use 0.3 to indicate 1/4 usage of a container Use 0.8 to indicate 3/4 usage of a container

PSNS 5090/132 (Rev. 04-13)

Title: CONDITION FOUND REPORT

Number: DI-MGMT-81648 Approval Date: 20040809 AMSC Number: N7531 Limitation: N/A DTIC Applicable: N/A GIDEP Applicable: N/A Office of Primary Responsibility: N PEO SHIPS-FL32 Applicable Forms: N/A

Use/Relationship: The Condition Found Report identifies needed repairs and recommends corrective action for work discovered during the contract performance period which are not covered by the work specifications.

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

Requirements:

1. Reference documents. N/A.

2. Format. The report shall be in contractor’s format.

3. Content. The report shall be serialized by CFR Number, and shall include the following:

a. Contract number, ship and hull number

b. Work Item Number to which the CFR relates

c. Date work requirement was discovered

d. Clear description of the work requirement

e. Specific location of the work requirement

f. Recommendation for corrective action

3.1 Recommendation for appropriate/best time to accomplish (i.e. during current availability with or without schedule change, future CNO or Continuous Maintenance Availability), and supporting rationale for the recommendation (such as cost efficiencies, availability of work force, availability of material, premium expenditures, etc.).

3.2 Cost and time estimates and the time frame for which it is valid, including:

a. Class “C” cost estimates. For work requirements which could be estimated within five working days, a class “F” estimate (+/-40%) identifying any potential impact which may affect the current schedule shall be included. The Class “F” estimate shall also contain the date on which a class “C” estimate will be provided.

b. Estimated Premium/Acceleration Costs, including premium costs for; material, subcontractors, man-hours, rework and any additional costs to on going work resulting from inclusion of the CFR work requirement.

c. Identification of related changes, if any, to the internal milestones and production and contract completion dates shall be included. When no changes were required a statement to that fact shall also be included

4. Media. The electronic media requirements shall be as specified in the contract on the DD 1423 CDRL.

5. End of DI-MGMT-81648

Source: https://assist.dla.mil -- Downloaded: 2017-09-29T12:43Z

REQUIRED INFORMATION FOR CONDITION FOUND REPORTS

The Condition Found Report (CFR) identifies needed repairs and recommends corrective action “for work discovered during the contract performance period which are not covered by the work specifications”.

Serialized by CFR Number (001, 002, 003…):

Contract number:

Ship and hull number:

Work Item Number to which the CFR relates (This can be the paragraph number from the Statement of

Work which applies – Paragraph 3.5 of SOW):

Date work requirement was discovered:

Clear description of the work requirement:

Specific location of the work requirement:

Recommendation for corrective action:

Recommendation for appropriate/best time to accomplish:

Supporting rationale for the recommendation:

Cost and time estimates:

Time frame for which estimate is valid:

Estimated Premium/Acceleration Costs:

Identification of related changes (production and contract completion dates):

DATA ITEM DESCRIPTION

Serialized by CFR Number 001 002 003:

Contract number:

Ship and hull number:

Work which applies Paragraph 35 of SOW:

Date work requirement was discovered:

Clear description of the work requirement 2:

Specific location of the work requirement:

Recommendation for corrective action 2:

Recommendation for appropriatebest time to accomplish:

Supporting rationale for the recommendation 2:

Cost and time estimates 2:

Time frame for which estimate is valid:

Estimated PremiumAcceleration Costs:

Identification of related changes production and contract completion dates 2:

Title: Work Completion Certification Certificate

Number: DI-MGMT-82050 Approval Date: 20160705

AMSC Number: N9679 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: MGMT-2016-043

Applicable Forms: N/A

Use/relationship: This DID will certify that all contracted work has been performed and completed.

This DID contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

1. Format. The report shall be similar to that of Sample Figure 1.

2. Content. The report shall contain all the information specified in Sample Figure 1.

Source: https://assist.dla.mil -- Downloaded: 2016-08-11T21:24Z

DI-MGMT-82050

DI-MGMT-82050

End of DI-MGMT-82050