C04.0 Exhibit A-CDRLs an DIDs.pdf

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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 and Communications 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

1_DATA_ITEM_NO: A003

2_TITLE_OF_DATA_ITEM: SAFETY DATA SHEET (SDS) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-SAFT-82112

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.5.6

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: N/A

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10 and 12: Report shall be submitted 5 business days after contract award.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: SAFT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:05:39-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:28:54-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A004

2_TITLE_OF_DATA_ITEM: CONDITION FOUND REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-81648*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.11

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 4: Delete paragraph 3.2.a.

Paragraph 3.2.b delete "Premium/Acceleration" and "premium".

Paragraph 3.2.c delete "internal milestones" and "and contract".

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 5 working days of work item requirement discovery.

Submit report within 24 hours of anticipated difficulty in meeting contract requirements and/or schedule dates.

For required reports that could result in a change in work to be accomplished or additional material to be procured, submit the required report in a time frame to allow the CO, via the COR, to initiate early action, but no later than the first 20 percent of the scheduled availability.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:06:31-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:38:35-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A005

2_TITLE_OF_DATA_ITEM: INCIDENT REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82071

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.13.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Report shall be submitted within 24 hours of investigation completion.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:07:14-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:29:25-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A006

2_TITLE_OF_DATA_ITEM: PAINT PRESERVATION APPENDICES

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-82120

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.16.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12 and 13: Submit documents to include Calibrated Electronic Data Logger records within 1 working day of completion of the following preservation operations: SSPC SP-1, Surface Profiles, Surface Conductivity/ Chloride and Top Coat Cure.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:07:45-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:38:01-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A007

2_TITLE_OF_DATA_ITEM: HAZARDOUS WASTE REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82129

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.17

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: N/A

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draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10 and 12: Submit report within 30 calendar days of project completion.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:08:23-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:29:59-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A008

2_TITLE_OF_DATA_ITEM: GAS FREE PROGRAM REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82093

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.21

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: *A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

addressee1: PSNS & IMF C/411 draft1: 1 reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

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draft5:

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draft38:

reg38x:

repro38:

total_draft: 1 total_repro: 0

16_REMARKS: BLOCK 8: Product shall be approved for technical content. Government requires 5 work days to review and comment. Contractor has 3 working days to incorporate comments and send back to the Government.

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, AND 13: BLOCK 10, 12, and 13: Submit report a minimum of 8 working days prior to the start of contract period of performance.

Submit revised report within 2 work days of a change to the Gas Free Program, Personnel, or Certifications/Qualifications.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:08:57-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:37:30-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A009

2_TITLE_OF_DATA_ITEM: TEST AND INSPECTION PLAN (TIP)

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82062*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.22.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: A*

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

addressee1: PSNS & IMF C/411 draft1: 1 reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

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draft5:

reg5:

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draft6:

reg6:

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draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 1 total_repro: 0

16_REMARKS: BLOCK 4: In Title Block Delete "and Inspection" and "(TIP)" In Use/Relationship; after the words "used to identify all" delete "inspections"; after the words "as well" delete "symbol (I) (V) (Q) (G) test/inspections and (G) governments notifications identified in the Work Item, and any additional"; after the words "additional tests" delete "and inspections".

In Format Line, Delete "I" in "TIP"

In Content Line, Delete "I" in "TIP"

Delete "as well as symbols (I)(V)(Q) test/inspections and (G)" Delete "Work Item number" Delete "be inspected" Delete "Inspection symbol (I, V, Q, G) Delete "Standard Item Number" Delete "Standard Item Paragraph" Delete "Name of Government Representative at Inspection" Delete "Inspection Date"

BLOCK 8: Government requires 5 working days prior to project start date to review and comment. Contractor has 3 working days to incorporate any changes and return to Government.

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12 and 13: Submit TIP 24 hours prior to each weekly scheduled production meeting. Final TIP submission shall be submitted within 24 hours after all testing is complete.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:09:52-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:30:29-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A010

2_TITLE_OF_DATA_ITEM: VESSEL DOCKING AND UNDOCKING PLAN

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82094

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.1.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: A*

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

addressee1: PSNS & IMF C/411 draft1: 1 reg1: 1 repro1:

addressee2: PSNS & IMF C/242 draft2: 1 reg2: 1 repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

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draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

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draft10:

reg10:

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draft11:

reg11:

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draft12:

reg12:

repro12:

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draft13:

reg13:

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draft14:

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draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 2 total_repro: 0

16_REMARKS: BLOCK 8: Product shall be approved for technical content. Government requires 5 work days to review and comment.

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit plan a minimum of 5 working days prior to docking and undocking the vessel.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Government Docking Observer (GDO) and the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 2

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:10:26-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:36:58-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A011

2_TITLE_OF_DATA_ITEM: VESSEL FINAL DOCKING REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82130

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.1.11

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: N/A

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2: PSNS & IMF C/242 draft2:

reg2: 1 repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

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draft5:

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draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10 and 12: Submit report within 5 working days of final undocking of the vessel.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Government Docking Observer (GDO) and the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 2

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:10:58-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:31:04-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A012

2_TITLE_OF_DATA_ITEM: ZINC ANODE LOCATION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82108

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.3.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: N/A

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

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draft3:

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draft25:

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repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

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addressee29:

draft29:

reg29:

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addressee30:

draft30:

reg30:

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addressee31:

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reg31:

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addressee32:

draft32:

reg32:

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addressee33:

draft33:

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draft34:

reg34:

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addressee35:

draft35:

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reg36:

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addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report a minimum of 4 working days prior to an undocking event.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:11:37-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:36:17-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A013

2_TITLE_OF_DATA_ITEM: STRUCTURAL INSPECTION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82065*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.5

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

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draft6:

reg6:

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draft7:

reg7:

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draft8:

reg8:

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draft9:

reg9:

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draft10:

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draft11:

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reg12:

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draft13:

reg13:

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draft14:

reg14:

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draft16:

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draft25:

reg25:

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draft26:

reg26:

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draft27:

reg27:

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draft37:

reg37:

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addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 4:

Use/Relationship Block: After the phrase "found during", delete "structural".

Use/Relationship Block: After the phrase "inspection of", delete "each exposed piping penetration, deck drain, deck plating and bulkheads for".

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:12:24-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:31:41-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A014

2_TITLE_OF_DATA_ITEM: ULTRASONIC TEST (UT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-NDTI-82095

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.6

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

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draft5:

reg5:

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draft6:

reg6:

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draft37:

reg37:

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addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test

BLOCK 14: Media requirement. The report shall be delivered electronically in

Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:12:48-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:35:35-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A015

2_TITLE_OF_DATA_ITEM: STRUCTURAL INSPECTION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82065*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.3.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

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draft5:

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draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 4:

Use/Relationship Block: After the phrase "found during", delete "structural".

Use/Relationship Block: After the phrase "inspection of", delete "each exposed piping penetration, deck drain, deck plating and bulkheads for".

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 8/24/2021

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Utility Float #9

E_CONTRACTPR_NO: N4523A-22-R-1053

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-08-24T13:13:18-0700

BESAW.DONALD.C.1294627711

2021-09-14T06:32:21-0700

LANGHAM.MATTHEW.ALLEN.1095218454

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 and Communications 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

1_DATA_ITEM_NO: A016

2_TITLE_OF_DATA_ITEM: AIR TEST REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-NDTI-82110

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.3.7

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

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