CDRL A001 - Maintenance Report.pdf

PREVIOUS EDITION MAY BE USED.

DD FORM 1423, FEB 2024 Page 1 of 2

UNCLASSIFIED

UNCLASSIFIED

CONTRACT DATA REQUIREMENTS LIST

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY:

TDP TM OTHER MGMT

D. SYSTEM/ITEM

Wagner Paint Proportioner

E. CONTRACT/PR NO.

TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Maintenance Service Report

3. SUBTITLE

Preventative Maintenance

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80995A

5. CONTRACT REFERENCE

PWS 2.3.6

6. REQUIRING OFFICE

309 MXSG/MASO

7. DD 250 REQ

LT

8. APP CODE

NA

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

ASREQ

11. AS OF DATE

NA

12. DATE OF FIRST SUBMISSION

Block 16

13. DATE OF SUBSEQUENT

SUBMISSION

Block 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

16. REMARKS

(9) DISTRIBUTION STATEMENT A: Approved for public release. Distribution is unlimited.

(12)(13) The contractor shall provide the report listing all work performed within two (2) days of completion of service of equipment listed in Appendix B of the PWS.

(14) One (1) copy of each submittal shall be provided electronically to each addressee in block 16 in Microsoft Office compatible format.

Addressees:

Erica Berry - TPOC erica.berry@us.af.mil

DSN: 586-1483

COMM: 801-586-1483

Mike Weston - 309 MXSS Supervision michael.weston@us.af.mil

DSN: 777-1941

COMM: 801-777-1941

Art Martinez - 309 MXSS Supervision arturo.martinez.5@us.af.mil

DSN: 775-3881

COMM: 801-775-3881

Joseph Knudson -309 MXSS Supervision joseph.knudson@us.af.mil

DSN: 777-6650

COMM: 801-777-6650

Jefferson Judd - 309 MXSS Supervision jefferson.judd@us.af.mil

DSN: 777-8022

COMM: 801-777-8022

Ryan Somerville-309 MXSG MASO ryan.somerville@us.af.mil

DSN: 775-0631

COM: 801-775-0631

Block 16 6

15.TOTAL

17. PRICE GROUP

NSP

18. ESTIMATED

TOTAL PRICE

0.00

G. PREPARED BY

Paulette Johnson

H. SIGNED ON 20260309 I. APPROVED BY

Erica Berry

J. SIGNED ON 20260310

JOHNSON.PAULETTE.

MARENIA.1269391410

Digitally signed by

JOHNSON.PAULETTE.MARENIA.12

69391410 Date: 2026.03.09 10:44:38 -06'00'

BERRY.ERICA.NI

COLE.1464304564

Digitally signed by

BERRY.ERICA.NICOLE.1464304564

Date: 2026.03.10 09:05:53 -06'00'

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoDM 5010.12 for detailed instructions.)

DD FORM 1423, FEB 2024 Page 2 of 2

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning," "Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support (e.g., Mission Design Series (MDS) designator).

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Name of preparer of CDRL.

Item H. Date CDRL was prepared and signature of preparer of CDRL.

Item I. Name of CDRL approval authority.

Item J. Date CDRL was approved and signature of CDRL approval authority.

Item 1. See DFARS Subpart 204.71 for proper numbering. To add or delete additional data items, point and click the plus or minus sign to the right of Block J.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Identify only one Data Acquisition Document No. If a single work task generates more than one deliverable data product, prepare a separate data item for each deliverable data product.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work/Performance Work Statement paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data and computer software, specify the contractor's requirement to mark the appropriate distribution statement on the technical data or computer software (ref. DoDI 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15.

Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14; Desired medium for delivery of the data item.

Identify for which data item additional remarks are provided. When tailoring the Data Acquisition Document invoked in Item 4, identify which portions of that Document are being tailored.

Identify any referenced attachments to the form. Attachments can be added using the button at the bottom of page 1.

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s rights to use the data shall be governed by the pertinent provisions of the contract.