C04.0 Exhibit A CDRLs & DIDs 15MWB9207 N4523A22R1060.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: A008

2_TITLE_OF_DATA_ITEM: MANUAL ENVIRONMENTAL READINGS REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-NDTI-82110

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.16.1.1.6

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*

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16_REMARKS: BLOCK 4: Title: Delete the following "Air Test"

USE/RELATIONSHIP BLOCK: Delete the following " Air Test" and insert "Manual Environmental Readings".

REQUIREMENTS BLOCK 2.1: Delete "Test Result" and insert "Manual Environmental Readings".

Delete the contents of BLOCKS 2.2 thru 2.4

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 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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: CLIN 003

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: 15MWB9207

E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-01-19T09:04:39-0800

LANGHAM.MATTHEW.ALLEN.1095218454

2021-01-19T09:04:51-0800

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: A024

2_TITLE_OF_DATA_ITEM: CHALK TEST REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-NDTI-82110

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.7.5

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*

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16_REMARKS: BLOCK 4: Title: Delete the following "Air" and insert "Chalk"

USE/RELATIONSHIP BLOCK: Delete the following " Air" and insert "Chalk"

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 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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: CLIN 003

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: 15MWB9207

E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-01-19T09:34:10-0800

LANGHAM.MATTHEW.ALLEN.1095218454

2021-01-19T09:34:30-0800

LANGHAM.MATTHEW.ALLEN.1095218454

DATA ITEM DESCRIPTION

Title: AIR TEST REPORT

Number: DI-NDTI-82110 Approval Date: 20170327

AMSC Number: N9783 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: NDTI-2017-003

Applicable Forms: N/A

Use/Relationship: The report will be used to provide Objective Quality Evidence (OQE) evidence of the contractor’s Air Test and to evaluate the need for vessel repairs that are not covered by the work specifications.

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.

Requirements:

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

2. Content. The Report shall contain:

2.1 Test result.

2.2 Recommendation for corrective action.

2.3 Estimated costs, including labor, subcontractors, material, rework, and any additional costs to on-going work resulting from the inclusion of the proposed work.

2.4 Identification of related changes, if any, to production completion dates.

End of DI-NDTI-82110

Source: https://assist.dla.mil -- Downloaded: 2017-03-28T14:41Z Check the source to verify that this is the current version before use.

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: 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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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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: CLIN 003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: 15MWB9207

E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-01-19T09:05:36-0800

LANGHAM.MATTHEW.ALLEN.1095218454

2021-01-19T09:05:56-0800

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: A025

2_TITLE_OF_DATA_ITEM: AIR TEST REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-NDTI-82110

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.8

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: Submit each report within 2 working days of test.

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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: CLIN 003

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: 15MWB9207

E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

of_pages: 1

Reset:

Title: Hazardous Waste Report

Number: DI-MGMT-82129 Approval Date: 20170608

AMSC Number: N9814 Limitation: N/A

Preparing Activity: SH Project Number: MGMT-2017-026

Use/Relationship: The Hazardous Waste Report will identify type, amount, and disposal cost of hazardous waste removed during the period of performance. It will provide the Government with evidence of proper hazardous waste disposal.

2. Content. The report shall contain:

2.1. Name, title, description, and quantity of each item.

2.2. Analysis used to identify the hazardous waste.

2.3. Copies of paid invoices and receipts for the disposal of hazardous wastes.

End of DI-MGMT-82129

Source: https://assist.dla.mil -- Downloaded: 2017-06-16T14:12Z

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: A026

2_TITLE_OF_DATA_ITEM: STRUCTURAL INSPECTION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82065*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.5.2

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 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

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A_CONTRACT_LINE_ITEM_NO: CLIN 003

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E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

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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: WEIGHT AND STABILITY REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-SESS-81404A*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.19

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*

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16_REMARKS: BLOCK 4: Paragraph 2.6 delete "from prior reports" and "and impact of future alterations".

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 report a minimum of 8 working days prior to each 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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 2

A_CONTRACT_LINE_ITEM_NO: CLIN 003

B_EXHIBIT: A

TDP:

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OTHER: SESS

DSYSTEMITEM: 15MWB9207

E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

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2021-01-19T09:06:53-0800

LANGHAM.MATTHEW.ALLEN.1095218454

Title: STRUCTURAL INSPECTION REPORT

Number: DI-MGMT-82065

AMSC Number: N9714

DTIC Applicable: No

Preparing Activity: SH

Approval Date: 20161003

Limitation: N/A

GIDEP Applicable: No

Project Number: MGMT-2016-052

Use/Relationship: This DID will report the conditions found during structural inspection of each exposed piping penetration, deck drain, deck plating and bulkheads for structural integrity, deterioration, pitting, cracks, and areas of damage or distortion.

1. Format. The report shall be in the contractor’s format.

2. Content. The report shall contain the following information:

a. Name and Hull number of ship

b. Job Order

c. Work Item

d. Paragraph numbers including standard item paragraph number

e. Compartment (number and name)

f. Date of inspection

g. Material condition

h. Deficiencies noted

i. Recommendation for repairs

End of DI-MGMT-82065

Source: https://assist.dla.mil -- Downloaded: 2016-10-13T13:23Z

Title: WEIGHT AND STABILITY REPORTS FOR IN-SERVICE SURFACE SHIPS

Number: DI-SESS-81404A Approval Date: 20110609 AMSC Number: N9202 Limitation: N/A DTIC Applicable: N/A GIDEP Applicable: N/A Office of Primary Responsibility: SH/SEA 05P3 Applicable Forms: N/A

Use/relationship: Weight and Stability reporting is required for in-service ships to ensure that ship’s weight and height of center of gravity above the bottom of the keel (KG) values are within the Naval Architectural limits and that stability characteristics are not compromised, as a result of authorized alterations. It provides the basis for planning for corrective or compensation for adverse conditions.

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.

Requirements:

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

2. Content. The report shall contain:

2.1. A table of contents.

2.2. For each ship, the report shall include light ship (Condition A) and full load (Condition D) displacement (in long tons), condition expected at the end of availability and recommended ballast or compensation measures.

2.3. For each availability, a matrix or table showing alteration number with title description. For each alteration, show weight added or removed (pounds), height of vertical center of gravity above baseline and associated moment, distance of the longitudinal center of gravity from the mid-perpendicular reference point and associated moment, and distance of the transverse center of gravity from the centerline and associated moment. All levers are carried to nearest hundredth of a foot and all moments are carried to nearest a foot-pound. Vertical levers shall be indicated by a “+” or a blank for above the baseline, and a “-“ for below the baseline. Longitudinal levers shall be indicated by an “F” or an “-“ for forward of the mid-perpendicular reference point, and an “A”, a “+” or a blank for aft of the mid-perpendicular reference point. Transverse levers shall be indicated by a “P”, a “+“ or a blank for port, and an “S” or a “-“ for starboard. When an alteration causes a change in loads, include in the table with the appropriate sign.

2.4. By hull, a Stability Summary of:

a. Full load displacement (long tons)

b. KG (feet)

Source: https://assist.dla.mil -- Downloaded: 2016-02-26T14:18Z

DI-SESS-81404A

c. Date of last inclining experiment

d. Current ballast installed (long tons)

e. Recommendations for inclining

2.5. Summaries for all required loading conditions, and their associated drafts (forward, aft, and mean), list, trim, KG, and metacentric height, uncorrected and corrected for free surface affect of liquids in tanks. Include effects of changes of loads as well as weight and moment of alteration installations.

2.6. Analysis results and discussion of reasons for weight changes from prior reports, and recommendations for reversing unsatisfactory trends, such as exceeding established Naval Architectural limits. Include recommendations for weight removals for compensations, ballast adjustments, need for an inclining experiment, and impact of future alterations.

2.7. Background information, studies, directives, correspondence and all detailed calculations pertaining to weights, including density factor. Where applicable, include alteration Weight and Moment Worksheets as background information.

3. Media Requirements. The media requirements shall be as specified in the contract.

4. End of DI-SESS-81404A. .

Source: https://assist.dla.mil -- Downloaded: 2016-02-26T14:18Z

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: GAS FREE PROGRAM REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82093

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.22

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*

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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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: CLIN 003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: 15MWB9207

E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

of_pages: 1

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LANGHAM.MATTHEW.ALLEN.1095218454

2021-01-19T09:07:46-0800

LANGHAM.MATTHEW.ALLEN.1095218454

Title: GAS FREE PROGRAM REPORT

Number: DI-MGMT-82093 Approval Date: 20161208

AMSC Number: N9754 Limitation: N/A

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

Use/Relationship: The Gas Free Program Report will provide the Government with proof of the

Contractor’s confined space entry/gas free certification processes and qualified personnel, including sub-contractors.

by the specific and discrete task requirements as delineated in the contract.

2. Content. The Gas Free Program Report shall contain the following Sections:

2.1 Objective.

2.2 Background.

2.3 Assignment of Responsibility for:

a. Employer

b. Program Manager

c. Entry Supervisors

d. Attendants

e. Rescue Team

f. Entrants/Affected Employees

2.4 Training:

a. Training Frequency

b. General Training

c. Specific Training

d. Verification of Training

2.5 Identification of Hazards and Evaluation of Confined Spaces:

a. Survey

b. Hazard Reevaluation

c. Pre-Entry Hazard Assessment

d. Hazard Controls

Source: https://assist.dla.mil -- Downloaded: 2017-01-05T18:11Z

DI-MGMT-82093

2.6 Entry Permits:

a. Key Elements of Entry Permits

b. Permit Scope and Duration

2.7 Entry Procedures:

a. Prior to Entry

b. Opening a Confined Space

c. Atmospheric Testing

d. Isolation and Lockout/Tagout Safeguards

e. Ingress/Egress Safeguards

f. Warning Signs and Symbols

2.8 Maintenance of Safe Conditions:

a. Conditions

b. Tests required

2.9 Emergency Response:

a. Emergency Response Plan

b. Retrieval Systems and Methods of Non-Entry Rescue

2.10 Current Roster of the following personnel:

a. Certified National Fire Protection Association (NFPA) Marine Chemists

b. Certified Industrial Hygienists

c. Qualified Competent Persons

End of DI-MGMT-82093

Source: https://assist.dla.mil -- Downloaded: 2017-01-05T18:11Z

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: TEST AND INSPECTION PLAN (TIP)

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82062*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.23.1

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*

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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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: CLIN 003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: 15MWB9207

E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

of_pages: 1

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LANGHAM.MATTHEW.ALLEN.1095218454

2021-01-19T09:08:34-0800

LANGHAM.MATTHEW.ALLEN.1095218454

Title: TEST AND INSPECTION PLAN (TIP)

Number: DI-MGMT-82062

AMSC Number: N9711

Project Number: MGMT-2016-049

Use/Relationship: This DID is used to identify all inspections and tests required by zero-tier references and first tier references, as well as symbols (I)(V)(Q) test/inspections and (G) government notification identified in the Work Item, and any additional tests and inspections the contractor deems necessary to substantiate product conformance.

Format. The TIP shall be in the contractor’s format.

Content. The TIP shall include the following information:

Ship’s name/hull number

Work Item number

Work Item Paragraph number

Identification of item/component to be inspected/tested

Standard Item Number

Standard Item Paragraph

Location

Sub-Contractor (if applicable)

Inspection Symbol (I, V, Q, G)

Accept/Reject Criteria

Test Result (Accept or Reject)

Notify Date

Notify Time

Request Date

Request Time

Inspection Date

Name of Person Notified

Name of Government Representative at Inspection

Name of Contractor’s authorized representative who witnessed/performed test.

End of DI-MGMT-82062

Source: https://assist.dla.mil -- Downloaded: 2016-12-06T20:05Z

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: COMPARTMENT INSPECTION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82063

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.24.1

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 report within 3 working days of each compartment 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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: CLIN 003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: 15MWB9207

E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-01-19T09:09:13-0800

LANGHAM.MATTHEW.ALLEN.1095218454

2021-01-19T09:12:01-0800

LANGHAM.MATTHEW.ALLEN.1095218454

Title: COMPARTMENT INSPECTION REPORT

Number: DI-MGMT-82063

AMSC Number: N9712

Project Number: MGMT-2016-050

Use/Relationship: This DID will be used to provide results of each compartment inspection, including discrepancies found, and provides objective quality evidence (OQE) for the work accomplished within the compartment.

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

Content. The report shall contain the following information:

Name and hull number of ship

Job Order

Work Item

Paragraph numbers including standard item paragraph number

Compartment (number and name)

Date of inspection

List of discrepancies and the identity of the Contractor responsibility and Government responsibility

Signature of Contractor representative

Signature of SUPERVISOR

Signature of Commanding Officer’s designated representative

End of DI-MGMT-82063

Source: https://assist.dla.mil -- Downloaded: 2016-10-13T13:27Z

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: COMPARTMENT CLOSEOUT SCHEDULE REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82076

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.24.3

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 report within 3 working days of each compartment 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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: CLIN 003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: 15MWB9207

E_CONTRACTPR_NO: N4523A22R1060

FCONTRACTOR: TBD

of_pages: 1

Reset:

2021-01-19T09:12:35-0800

LANGHAM.MATTHEW.ALLEN.1095218454

2021-01-19T09:12:50-0800

LANGHAM.MATTHEW.ALLEN.1095218454

Title: COMPARTMENT CLOSEOUT SCHEDULE REPORT

Number: DI-MGMT-82076

AMSC Number: N9727

Project Number: MGMT-2016-066

Use/Relationship: This DID will identify each compartment where work has been completed and work that remains to be accomplished.

Content.

The report shall contain the following information:

A list of each compartment where work has been completed and work that remains to be accomplished. Include each compartment number and name and any work not completed by the

Work Item number.

A brief summary of the work that remains to be accomplished by the contractor.

Any impact that known Ship's Force work will have on the contractor.

The date when the contractor expects to complete his work within each compartment. Highlight major trouble spots.

Index the compartment closeout schedule by compartment number listing the page number of where the information about the compartment can be located.

The Report shall provide for completion of the following compartments, including associated machinery, equipment, electrical, alarm, control, piping, and ventilation systems, prior to the crew move aboard milestone date:

Messing, berthing, and living compartments, including galley, scullery, pantry, mess decks, walk-in freezer, chill and thaw boxes, dry provisions and breakout storerooms, wardroom, CPO mess, berthing compartments, staterooms, lounges, wash rooms, water closets and showers, laundry, and associated access routes and passageways that have had other than cable installation performed.

Source: https://assist.dla.mil -- Downloaded: 2016-10-18T14:24Z

DI-MGMT-82076

Refrigeration and air conditioning machinery rooms.

CHT machinery spaces and tanks.

Medical and dental spaces

End of DI-MGMT-82076

Source: https://assist.dla.mil -- Downloaded: 2016-10-18T14:24Z

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).