CDRL A001 Exhibit A -Certificate of Compliance.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 DATA ITEM)

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER MISC1

D. SYSTEM/ITEM

Low Pressure Resin Catch Tank

E. CONTRACT/PR NO.

TBD

F. CONTRACTOR

Energy Solutions

1. DATA ITEM NO

A001

2. TITLE OF DATA ITEM

CERTIFICATE OF COMPLIANCE

3. SUBTITLE

Certificate of Compliance

4. AUTHORITY (Data Acquisition Doc. No)

DI-MISC-81356A (see block 16)

5. CONTRACT REFERENCE

SOW Para. 3.2.1.2 , Para 3.2.1.14, and Para 3.2.1.15

6. REQUIRING OFFICE

NNSY Code 2380

7. DD 250 REQ

LT

9. DIST STATEMENT

REQUIRED

B*

10. FREQUENCY

ASREQ*

12. DATE OF FIRST SUBMISSION

ASREQ*

14. DISTRIBUTION

8. APP CODE

N/A

11. AS OF DATE

See blk 16

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ*

ADRESSEES Draft

Final

Reg Repro

16. REMARKS

Block 4: DID shall be tailored as follows: Section 2.g does not apply.

Block 9: DISTRIBUTION B. Distribution to U.S. Government Agencies and their contractors (administrative and operational use, 13 November 2020). Other requests for this document shall be referred to Norfolk Naval Shipyard, Portsmouth, VA.

Blocks 10, 11, 12, and 13: Submission is required for each tank. Submittal of the certificate of compliance shall be made prior to delivery of the low pressure resin catch tank to the end user.

Block 14: Data submission shall be via email attachment to the NNSY addressees listed below. The data format shall be PDF.

ADDRESSEE LIST, NNSY C/2380

Scott Young, Code 2380 Phone 757-396-1899 Email scott.a.young4@navy.mil

Stephen Barush, Code 2380 Phone 757-396-1898 Email stephen.barush@navy.mil

NNSY

C/2380

0 2 0

15. TOTAL 0 2 0

G. PREPARED BY

H. DATE

6/1/2021

I. APPROVED BY

J. DATE

17. PRICE

GROUP

18. ESTIMATED

TOTAL PRICE

NNSY Code 2380