CDRL A006 Proof Load Cert (0135 H53K O-Level Bag Group D-TBD).pdf

APPENDEX A: CONTRACT DATA REQUIREMENTS LIST (CDRL)

17. PRICE GROUP

Group IV

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved OMB No. 0704-0188

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 this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302 and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

F

C. CATEGORY:

TDP TM OTHER XX

D. SYSTEM/ITEM

CH-53K Organizational Level SE

E. CONTRACT/PR NO.

TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A006

2. TITLE OF DATA ITEM

PROOF LOAD CERTIFICATIONS

3. SUBTITLE

See Block 16

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

SOW Paragraph 3.3

6. REQUIRING OFFICE

BL22100

7. DD 250 REQ

YES

9. DIST STATEMENT

REQUIRED

D

10. FREQUENCY

AS REQ

12. DATE OF FIRST SUBMISSION

See Block 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT SUBMISSION

N/A Draft

Final

Reg. Repro

16. REMARKS

Block 3: This submittal shall include: Proof-load Certifications. The load shall be applied in a smooth manner and held for a period structural deformation, or other signs of failure shall be cause for rejection.

Block 4: Certifications Documentation Shall be delivered in Adobe Portable Document Format (PDF) formats.

Block 7: Each item manufactured as part of this contract shall have passed a Government final inspection prior to DD-250. Government Inspection and Acceptance of all production units shall be accomplished at the destination by a Government representative.

Block 9: Use Distribution Statement D. Distribution authorized to DoD and DoD Contractors only, (30 January 2007) other U.S. requests shall be referred to Code BL22100

Block 12: Applicable Certificates shall be placed in a plastic pouch/envelope and attached to each corresponding end item that is DD-250’d to the Government . A copy of all Certificates for each end article shall be submitted to CH-53K Support Equipment Engineer (Ed Ceralde) in Adobe Portable Document Format (PDF) formats.

Block 14: Certificates shall be delivered to POC Ed Ceralde(CH-53K SE Engineering)

(732) 323-4664

Email Address: edward.v.ceralde.civ@us.navy.mil

POC 0 1 1

15. TOTAL 0 1

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

03/03/26 03/03/26