C04.0 N4523A23R1054 UFDD-132 & UFDD-133 Exhibit A CDRLs and 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: A012

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 3.1.13

6_REQUIRING_OFFICE: PSNS & IMF C/101

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/101, 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:

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 2

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: UFDD 132

E_CONTRACTPR_NO: N4523A23R1054

FCONTRACTOR: TBD

of_pages: 1

Reset:

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: A027

2_TITLE_OF_DATA_ITEM: CERTIFICATION/DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-80678*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.16.3.1

6_REQUIRING_OFFICE: PSNS & IMF C/101

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:

Preparation Instructions Block: Delete paragraphs 10.1, 10.2.2, 10.2.3, 10.2.4.

Paragraph 10.2.1, Delete after the word Objective evidence, "may", Delete after the words "such items as", spectrographs, radiographs, material sampling, analysis"

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/101, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection and 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: 16 NOV 2022

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: UFDD 133

E_CONTRACTPR_NO: N4523A23R1054

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-16T11:43:41-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

Source: https://assist.dla.mil -- Downloaded: 2016-02-24T13:38Z Check the source to verify that this is the current version before use.

Source: https://assist.dla.mil -- Downloaded: 2016-02-24T13:38Z

DATA ITEM DESCRIPTION

Title: VESSEL FINAL DOCKING REPORT

Number: DI-MGMT-82130 Approval Date: 20170608

AMSC Number: N9815 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: MGMT-2017-027

Applicable Forms: NAVSEA Forms 9997/1 through 9997/5

Use/Relationship: The report will document the results of various vessel drydocking evolutions. It will provide the Government with historical information to be applied to future drydockings.

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.

The NAVSEA forms 9997/1 through 9997/5 can be obtained as specified in the contract.

Requirements:

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

2. Content. The Vessel Final Docking Report shall contain completed NAVSEA forms

9997/1 through 9997/5 applicable to each vessel.

End of DI-MGMT-82130

Source: https://assist.dla.mil -- Downloaded: 2017-06-16T14:14Z

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: ZINC ANODE LOCATION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82108

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.3.3

6_REQUIRING_OFFICE: PSNS & IMF C/101

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/101, 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: 15 NOV 2022

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: UFDD 132

E_CONTRACTPR_NO: N4523A23R1054

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T13:56:58-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

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: A028

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/101

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/101, 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: 16 NOV 2022

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: UFDD 133

E_CONTRACTPR_NO: N4523A23R1054

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-16T12:43:06-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

Title: ZINC ANODE LOCATION REPORT

Number: DI-MGMT-82108 Approval Date: 20170327

AMSC Number: N9781 Limitation: N/A

Preparing Activity: SH Project Number: MGMT-2017-016

Applicable Forms: N/A

Use/Relationship: The report will provide detailed current zinc anode locations of the underwater hull of vessel(s).

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

2. Content. The Zinc Anode Location report shall contain a sketch of the underwater body and freeboard plating surfaces with the following information:

2.1 Specific locations of fixed hull structural members.

2.2 Specific locations of docking block locations.

2.3 Specific locations of hull reference points.

2.4 Specific measurements of zinc anodes to docking block locations.

2.5 Specific measurements of zinc anodes to hull reference points.

2.6 Specific measurements of zinc anodes to fixed hull structural members.

End of DI-MGMT-82108

Source: https://assist.dla.mil -- Downloaded: 2017-03-30T17:25Z

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: A014

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*

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total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 4:

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

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/101, 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: 15 NOV 2022

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: UFDD 132

E_CONTRACTPR_NO: N4523A23R1054

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T14:01:22-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

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: A029

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/101

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/101 draft1: 1 reg1: 1 repro1:

addressee2:

draft2:

reg2:

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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/101, 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: 16 NOV 2022

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: UFDD 133

E_CONTRACTPR_NO: N4523A23R1054

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-16T11:47:57-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

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: 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: A015

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:

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draft3:

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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 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: 15 NOV 2022

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: UFDD 132

E_CONTRACTPR_NO: N4523A23R1054

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T14:04:21-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

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: A030

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/101

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/101 draft1: 1 reg1: 1 repro1:

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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/101, 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: 16 NOV 2022

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: UFDD 133

E_CONTRACTPR_NO: N4523A23R1054

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-16T11:54:05-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

Title: Ultrasonic Test (UT) Report

Number: DI-NDTI-82095 Approval Date: 20161208

AMSC Number: N9756 Limitation: N/A

Preparing Activity: SH Project Number: NDTI-2017-002

Use/Relationship: The Ultrasonic Test (UT) Report will document the results of Ultrasonic

Testing. It will provide the Government with evidence of structural damage and deterioration.

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

2. Content. The UT report shall include the following:

a. Contractor’s name and address.

b. Contract number.

c. Work item number.

d. Paragraph number.

e. Date of report.

f. Test results.

End of DI-NDTI-82095

Source: https://assist.dla.mil -- Downloaded: 2017-01-05T18:03Z

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: A016

2_TITLE_OF_DATA_ITEM: STRUCTURAL INSPECTION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82065*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.2

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:

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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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 15 NOV 2022

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: UFDD 132

E_CONTRACTPR_NO: N4523A23R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T14:06:44-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

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: A031

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/101

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/101 draft1: 1 reg1: 1 repro1:

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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/101, 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: 16 NOV 2022

1_APPROVED_BY:

J_DATE:

Page: 1 reg38t: 2

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: UFDD 133

E_CONTRACTPR_NO: N4523A23R1054

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-16T11:58:18-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

Title: STRUCTURAL INSPECTION REPORT

Number: DI-MGMT-82065

AMSC Number: N9714

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: VESSEL DOCKING AND UNDOCKING PLAN

Number: DI-MGMT-82094 Approval Date: 20161208

AMSC Number: N9755 Limitation: N/A

Preparing Activity: SH Project Number: MGMT-2017-002

Use/Relationship: The plan will document a detailed plan to safely dock and undock the vessel(s). It is used by the Government to review, comment, and approve docking and undocking plans prior to each docking and undocking evolution.

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

2. Content. The Plan shall include the following Docking Procedures:

a. Operating Practices

b. Safety and Security Plans

c. Special precautions or actions required by the characteristics of the dock, marine railway, or other docking methods

d. Pumping/flooding schedule

e. Specific list, trim, and stability requirements

3. The Plan shall contain:

a. Set and align docking blocks

b. A scaled drawing including block size, block spacing, and location of vessel with respect to the blocks at landing

c. Docking clearances utilizing references for guidance

d. The use of haul, fixed, or fitted blocks

e. The number, distance from centerline, and square footage of the side blocks per side sufficient to resist overturning moments

4. The Plan shall show that at least 90 percent of blocks land on longitudinal strength members or main transverse bulkheads.

End of DI-MGMT-82094

Source: https://assist.dla.mil -- Downloaded: 2017-01-10T14:39Z

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: A001

2_TITLE_OF_DATA_ITEM: Contractor's Progress, Status and Management Report

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-80227*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.5.1

6_REQUIRING_OFFICE: PSNS & IMF C/101

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: WEKLY*

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 10.2: Delete "This report shall be typewritten on standard size (e.g. 8 1/2" by 11'") white paper, and securely stapled.".

Delete Paragraphs 10.3.d; 10.3.g; 10.3.i; 10.3.j; 10.3.k; 10.3.l.

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/101, Bremerton, WA 98314.

BLOCK 10, 12, and 13:

Submit first report 5 working days prior to project start date.

Submit report 24 hours prior to each weekly scheduled production meeting.

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: 15 NOV 2022