CDRL A002_Test Inspection Report.pdf

CONTRACT DATA REQUIREMENTS LIST (CDRL)

(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. B. EXHIBIT C. CATEGORY:

TBD A TDP TM _____ OTHER NDTI

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

MK48 CABLE ASSEMBELY, 203W3, FES TBD N/A

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

A002 TEST/INSPECTION REPORT QUALITY, TEST, AND INSPECTION REPORT III

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

DI-NDTI-80809B STATEMENT OF WORK NUWC DIVISION, KEYPORT

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

DD REQUIRED ASREQ SEE BLK 16

a. ADDRESSEE

b. COPIES

8. APP CODE

D (SEE BLK 16)

11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

NA SEE BLK 16 SEE BLK 16 Reg Repro

16. REMARKS TECHNICAL POC 0 1

BLK 5: THE QUALITY, INSPECTION AND TEST REPORT SHALL BE GENERATED FOR ALL UNITS

AND SUBMITTED WITH THE MATERIAL DELIVERY FOR DESTINATION ACCEPTANCE, IAW THE

STATEMENT OF WORK (SOW) PARA 3.1.2., 3.1.3.1. AND 3.1.5.1.

THE REPORT SHALL VERIFY MATERIAL CONFORMANCE, BY SERIAL NUMBER, TO MEET THE

APPLICABLE DRAWINGS, SPECIFICATIONS, SOW, AND CONTRACT REQUIREMENTS.

IN ADDITION, THE REPORT SHALL INCLUDE MATERIAL, COMPONENT, PROCESSES AND

ASSEMBLY CERTIFICATIONS OF CONFORMANCE (COC) AND ALL THE PERTINENT OBEJECTIVE

QUALITY EVIDENCE FOR EACH ORDER.

BLK 9: DISTRIBUTION STATEMENT "D" - DISTRIBUTION AUTHORIZED TO DOD AND U.S. DOD

CONTRACTORS ONLY; CRITICAL TECHNOLOGY, EXPORT CONTROLLED (4/29/2021). OTHER

REQUESTS SHALL BE REFERRED TO PEO-SUBS (PMS404).

WARNING" THIS DOCUMENT CONTAINS TECHNICAL DATA WHOSE EXPORT IS RESTRICTED BY

THE ARMS EXPORT CONTROL ACT (TITLE 22, U.S.C. SEC. 2751 ET. SEQ.) OR THE EXPORT

ADMINISTRATION ACT OF 1979, AS AMENDED, TITLE 50, U.S.C. APP. 2401 ET. SEQ. VIOLATORS OF

THESE EXPORT LAWS ARE SUBJECT TO SEVERE CRIMINAL PENALTIES. DISSEMINATE PER THE

PROVISIONS OF DOD DIRECTIVE 5230.25.

DESTRUCTION NOTICE - FOR UNCLASSIFIED, LIMITED DOCUMENTS, DESTROY BY ANY METHOD

THAT WILL PREVENT DISCLOSURE OF CONTENTS OR RECONSTRUCTION OF THE DOCUMENT.

BLK 10: NUWCDIVKPT WILL HAVE 45 DAYS TO ACCEPT/REJECT THE DELIVERY.

BLK 14: CONTROLLED UNCLASSIFIED INFORMATION (CUI) CAN BE PROVIDED ELECTRONICALLY

FOR DESTINATION ACCEPTANCE. ALL EMAIL MUST BE DIGITALLY SIGNED AND ENCRYPTED TO

NAVY.MIL ADDRESS ONLY.

DELIVERABLE FORMAT: DOCUMENT: ADOBE PDF (.PDF, SEARCHABLE) OR MICROSOFT WORD

(.DOC) OR SPREADSHEET MICROSOFT EXCEL (.XLS)

DISTRIBUTION ADDRESSEES AND ELECTRONIC MAILING ADDRESSES: NUWC DIVISION

KEYPORT, JACQUELINE.M.GLASS.CIV@US.NAVY.MIL AND MICHAEL VAN DEMARK

(MICHAEL.T.VANDEMARK.CIV@US.NAVY.MIL)

CONTRACTING OFFICER 0 1

15. TOTAL ▬▬▬▬► 0 2

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

JACQUELINE GLASS

4 AUGUST2021

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 1 of 1 Pages