C08.0 Exhibit A - CDRLs Package.pdf

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 (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 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

0002 A X

THERMAL SPRAY SNORKEL STANDPIPE N4523A22Q1365 TBD

A001 CERTIFICATION/DATA REPORT PROOF OF FACILITY & SPRAY OPERATOR

CERTIFICATION

DI-MISC-80678 PWS PARAGRAPH 5.1 PSNS and IMF

LT

N/A D

OTIME

See BLK 16

ASREQ

See BLK 16 See Block 16 1

0 1 0

Block 3: As part of their proposal, the offeror shall provide documentention in accordance with PWS paragraph 5.1 (per reference 8.2 paragraphs 3.2.1, 3.2.3.2, 3.2.3.5 and 3.3.1.1).

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

Block 11 and 13: Submit within 5 days of award of contract.

PEPA.BERNARDO.OSIANG.1174

903731

Digitally signed by

PEPA.BERNARDO.OSIANG.1174903731

Date: 2022.08.16 11:38:04 -07'00'

08/16/22

WILLIAMS.MATTHEW.SCOTT.1156405864

Digitally signed by

WILLIAMS.MATTHEW.SCOTT.1156405864

Date: 2022.08.16 11:53:56 -07'00'

8/16/22

1 2 Adobe Professional 8.0

(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 (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 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

0002 A X

THERMAL SPRAY SNORKEL STANDPIPE N4523A22Q1365 TBD

A002 QUALITY ASSESSMENT REPORT QUALITY ASSESSMENT RECORD

DI-QCIC-81187 PWS PARAGRAPH 5.5 PSNS and IMF

LT

N/A D

OTIME

See BLK 16

ASREQ

See BLK 16 See Block 16 1

0 1 0

Block 3: The contractor shall provide one legible copy, in approved transferrable media, of the sprayed component record form that meets the minimum requirements of para. 3.1.3 of Reference 6.2 to the COR upon completion of coating application per PWS para. 5.5.

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

Block 11 and 13: Submit within 48 hours of work completion.

PEPA.BERNARDO.OSIANG.1174

903731

Digitally signed by

PEPA.BERNARDO.OSIANG.1174903731

Date: 2022.08.16 11:41:52 -07'00'

08/16/22

WILLIAMS.MATTHEW.SCOTT.1156405864

Digitally signed by

WILLIAMS.MATTHEW.SCOTT.1156405864

Date: 2022.08.16 11:56:30 -07'00'

8/16/22

(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 (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 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

0002 A X

THERMAL SPRAY SNORKEL STANDPIPE N4523A22Q1365 TBD

A003 COMPLETION REPORT PWS PARAGRAPH 5.6

DI-MGMT-82061 PWS Paragraph 5.6 PSNS and IMF

LT

N/A D

OTIME

See BLK 16

ASREQ

See BLK 16 See Block 16 1

0 1 0

Block 3: The contractor shall provide one legible copy, in approved transferrable media, of a completion report for Snorkel Standpipe Repair per PWS paragraph 5.6.

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

Block 11 and 13: Submit within 48 hours of work completion.

PEPA.BERNARDO.OSIANG.1174

903731

Digitally signed by

PEPA.BERNARDO.OSIANG.1174903731

Date: 2022.08.16 11:45:55 -07'00'

08/16/22

WILLIAMS.MATTHEW.SCOTT.1156405864

Digitally signed by

WILLIAMS.MATTHEW.SCOTT.1156405864

Date: 2022.08.16 11:58:20 -07'00'

8/16/22