CDRL Addendum.pdf

Enclosure (3)

CONTRACT DATA REQUIREMENTS LIST

(2 DATA ITEMS)

Form Approved

OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 440 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 complete 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

0001 TBD TDP_______ TM ______________________ OTHER _______See Block 16_______________________

D. SYSTEM / ITEM

Digital Launch Control Display Panels (LCDPs)

E. CONTRACT / PR NO.

N66604-23-SIMACQ-NPT-45-0027

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Status Report

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80368A

5. CONTRACT REFERENCE

SOW 4.1.1

6. REQUIRING OFFICE

NUWCDIVNPT Code 4524

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT Monthly See Block 16 b. COPIES

8. APP CODE D 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Draft

Final

N/A (See Block 16) See Block 16 See Block 16 Reg Repro

16. REMARKS C45 TPM 0 1 0

Block 4 : Contractor format acceptable. C45 TPOC 0 1 0

Block 9: See Block 16 Addendum

Block 10-13: The Contractor shall deliver a monthly status report, beginning 30 days after the effective date of this contract, with subsequent submissions every 30 days thereafter. It is estimated that 12 monthly reports shall be submitted

Block 14: Reg copy to be delivered via email or electronic submission

Block C, Category- Other : MGMT

15. TOTAL ----------------> 0 2

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

Failure Analysis & Corrective Action Report (FACAR)(NAVY)

3. SUBTITLE

See Block 16

4. AUTHORITY (Data Acquisition Document No.)

DI-SESS-81927

5. CONTRACT REFERENCE

SOW 4.1.1, 4.2.1, 4.3.1

6. REQUIRING OFFICE

NUWCDIVNPT Code 452/4524

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT ASREQ See Block 16 b. COPIES

A (See Block 16) N/A See Block 16

16. REMARKS C45 TPM 1 1 0

Block 4 : Contractor format acceptable. C45 TPOC 1 1 0

Block 9: See Block 16 Addendum 1 1 0

Block 12-13: Contractor shall deliver reports within 5 days after each occurrence. The government will review and comment within 5 days. Contractor will submit final 5 days after Government comments. It is estimated that up to 2 submissions per LCDP, per task, shall be submitted.

Block 3: SOW 4.1.1: Failure Analysis & Corrective Action Report

SOW 4.2.1: Failure Analysis & Corrective Action Report (at Origin)

SOW 4.3.1: Failure Analysis & Corrective Action Report (at Destination)

Block C, Category- Other : SESS

15. TOTAL ---------------> 3 3 0

G. PREPARED BY

Brad Rotsky

H. DATE

03/13/2023

I. APPROVED BY

J. DATE

DD Form 1423-2, AUG 96 eg Previous editions may be used

Form Approved

OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 440 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 complete 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

0001 TBD TDP_______ TM ______________________ OTHER ________X_______________________

D. SYSTEM / ITEM

Digita Launch Control Display Panels (LCDPs)

E. CONTRACT / PR NO.

N66604-23-SIMACQ-NPT-45-0027

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM

Request for Variance

DI-SESS-80640D

5. CONTRACT REFERENCE

SOW 4.1.1

6. REQUIRING OFFICE

NUWCDIVNPT Code 4524

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT ASREQ See Block 16 b. COPIES

A (See Block 16) N/A See Block 16 Reg Repro

16. REMARKS C45 TPM 1 1 0

Block 7: Deliver draft on LT; deliver final on DD. C45 TPOC 1 1 0

Block 9: See Block 16 addendum 1 1 0

Block 12-13: Contractor shall deliver RFV within 10 days after identification of configuration item issue.

The Government with review and comment within 15 days after receipt of RFV. Upon government approval of RFV, the contractor shall incorporate change and proceed with LCDP production. It is estimated that up to 10 RFVs shall be submitted

15. TOTAL ----------------> 3 3 0

2. TITLE OF DATA ITEM

5. CONTRACT REFERENCE

6. REQUIRING OFFICE

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

16. REMARKS

******* Intentionally Blank *******

15. TOTAL --------------->

Brad Rotsky

H. DATE

Form Approved

OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 440 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 complete 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

0001 TBD TDP_______ TM ______________________ OTHER ________See Block 16______________________

D. SYSTEM / ITEM

Digita Launch Control Display Panels (LCDPs)

E. CONTRACT / PR NO.

N66604-23-SIMACQ-NPT-45-0027

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A004

2. TITLE OF DATA ITEM

Technical Report – Study/Services

3. SUBTITLE

Objective Quality Evidence (OQE) Report

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW 4.2.1

6. REQUIRING OFFICE

NUWCDIVNPT Code 4524

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT See Block 16 See Block 16 b. COPIES

N/A (See Block 16) See Block 16 N/A Reg Repro

16. REMARKS C45 TPM 0 1 0

Block 4 : Contractor format acceptable. C45 TPOC 0 1 0

Block 9: See Block 16 Addendum 0 1 0

Block 10-12: Contractor shall deliver report within 15 days after completion of testing performed at Origin. One OQE Report per LCDP is required.

Block C, Category- Other : MISC

15. TOTAL -------------- 0 3 0

A005

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

See Block 16

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW 4.2.1, 4.3.1

6. REQUIRING OFFICE

NUWCDIVNPT Code 4524

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT ASREQ See Block 16 b. COPIES

N/A (See Block 16) N/A N/A

16. REMARKS C45 TPM 0 1 0

Block 4 : Contractor format acceptable. C45 TPOC 0 1 0

Block 9: See Block 16 Addendum 0 1 0

Block 10-12: Contractor shall deliver report within 15 days after completion of tests. Estimate 1 submittal for each LCDP. It is estimated that up to 10 Test/Inspections reports shall be submitted per LCDP, per task.

Block 3: SOW 4.2.1: Non-Destructive Test (NDT) Report

SOW 4.3.1: Fitment and Functional Test/Inspection Report

Block C, Category- Other : NDTI

15. TOTAL ------------- 0 3 0

Brad Rotsky

H. DATE

E. APPROVED BY

Form Approved

OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 440 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 complete 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

0001 TBD TDP_______ TM ______________________ OTHER ________X_______________________

D. SYSTEM / ITEM

Digita Launch Control Display Panels (LCDPs)

E. CONTRACT / PR NO.

N66604-23-SIMACQ-NPT-45-0027

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A006

2. TITLE OF DATA ITEM

Acceptance Test Report

3. SUBTITLE

Quality Assurance (QA) Provisions

4. AUTHORITY (Data Acquisition Document No.)

DI-QCIC-81891

5. CONTRACT REFERENCE

SOW 4.2.1, 4.3.1

6. REQUIRING OFFICE

NUWCDIVNPT Code 4524

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT ASREQ See Block 16 b. COPIES

N/A (See Block 16) N/A N/A Reg Repro

16. REMARKS C45 TPM 0 1 0

Block 4 : Contractor format acceptable. C45 TPOC 0 1 0

Block 9: See Block 16 Addendum 0 1 0

Block 10-12: Contractor shall deliver report for each LCDP within 15 days prior to delivery of hardware.

It is estimated that up to 2 QA Provisions reports shall be submitted per LCDP, per task.

Block C, Category- Other : QCIC

15. TOTAL ----------------> 0 3 0

A007

2. TITLE OF DATA ITEM

Certificate of Compliance

DI-MISC-81356A

5. CONTRACT REFERENCE

SOW 4.2.1, 4.3.1, 4.4.1

6. REQUIRING OFFICE

NUWCDIVNPT Code 4524

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT ASREQ See Block 16 b. COPIES

N/A (See Block 16) N/A N/A

16. REMARKS C45 TPM 0 1 0

Block 4: Contractor format acceptable C45 TPOC 0 1 0

Block 9: See Distribution Statement Addendum 0 1 0

Block 10-12: The Contractor shall deliver a Certificate of Compliance for each LCDP hardware deliverable including kit items.

Block C, Category- Other : MISC

15. TOTAL ---------------> 0 3 0

Brad Rotsky

H. DATE

ERP PR# N66604-23-SIMACQ-NPT-45-0027

DD FORM 1423

BLOCK 16 ADDENDUM

Block 9: the following information is amplification of the Block 9 Distribution Statement Selected:

Distribution Statement paragraphs is in addition to CLASSIFICATION markings of the data.

Distribution statement D: Applies to CDRL item Nos. A001-A007.

Distribution authorized to the DoD and DoD contractors only; CRITICAL TECHNOLOGY (date data generated). Other requests for this document shall be referred to NUWC Division, Newport (Code 4524).

The following “EXPORT CONTROL WARNING NOTICE” must be used in conjunction with DISTRIBUTION STATEMENT identified in the above CDRL items.

Warning – This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. Sec 27521 et seq.) or the Export Administration Act of 1979, as amended, title 50, U.S.C., App 2401 et seq. Violation of these exports laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.