CDRL - Colenta Xray PM and Repair v2 signed.pdf

Statement of Work (SOW) Contract Data Requirements List (DD 1423s)

TITLE

FRCSW, Building 250

Date 05/18/2026

Colenta X-ray Preventative Maintenance and Repair

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) 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 thus burden estimate or any other aspect of this collection o f 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. B. EXHIBIT C. CATEGORY:

0001, 0002, 0004, and all subsequent options

A TDP TM OTHER

X

D. SYSTEM|ITEM F. CONTRACTOR

Colenta X-ray PM and Repair

E. CONTRACT/PR NO.

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

GROUP

A001 Contract Field Service Report Field Service Report (FSR)

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

TOTAL PRICE

DI-MGMT-81238

Section: 4.1.11; 4.2; 4.4 FRCSW

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

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

NO ASREQ ASREQ b. COPIES

8. APP CODE A 11. ASN/A OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRAFT FINAL

N/A N/A N/A TPOC Reg Repr o

16. REMARKS

Block 10: As Required Block 12: As Required

SOW SECTIONS:

TPOC 1

4.1.11 Upon completion of PM, the FST will provide the TPOC with a Field Service Report (FSR). The FSR shall include the name of the FST performing the exchanges/repairs, the location and date the work was performed, the services performed, time spent on the service, and a list of recommended parts or services to be performed prior to the next service

4.2 In the event the FST believes the equipment requires service beyond PM, the FST shall detail these discrepancies on the FSR and notify the TPOC via email. The FST shall provide a quote identifying parts required, parts cost, labor hours required, and labor cost. This Repair CLIN is optional and requires contract modification to exercise.

4.4.1 In the event the Contractor identifies discrepancies or determines that additional parts and/or services other than what is listed on this SOW are needed, the Contractor shall notify the TPOC and Contracting officer via email and supply an FSR detailing these discrepancies as well as a quote to perform the additional work.

15. Total

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

Khoi A. Nguyen 5/18/2026

DD FORM 1423-1, JUN 90 (EG) Previous editions are obsolete Page 1 of 1 Pages

DISTRIBUTION STATEMENT ON TECHNICAL DOCUMENTS

The purpose of this supplement attachment is to establish procedures for marking technical documents, including production, engineering and logistics information, to denote the extent to which they are available for distribution, release, and dissemination without additional approvals or authorizations.

Distribution covers all engineering drawings, standards, specifications, technical manuals, blueprints, drawings, plans, instructions, computer software and documentation, and other technical information that can be used or be adapted for use to design, engineer, produce, manufacture, operate, repair, overhaul, or reproduce any military or space equipment or technology concerning such equipment.

The distribution statement markings shall be mandatory for all technical documents, including such informal documents as working papers, memoranda, and preliminary reports if those documents are not already in the public domain and if they are likely to be disseminated outside of the Department of Defense.

The distribution statement shall be displayed conspicuously on technical documents so as to be recognized readily by recipients.

The following shall apply for standard written or printed material:

1. The distribution statement shall appear on each front cover, title page, and DD Form 298 “Report Documentation Page”.

2. When practicable, the abstract of the document, the DD Form 1423 and bibliographic citations shall be written in such a way that the information will not be subject to distribution statement B.

If the technical information is not prepared in the form of an ordinary document and does not have a cover or title page (such as forms and charts), the applicable distribution statement shall be stamped, printed, written, or affixed by other means in a conspicuous position.

A distribution statement marking is distinct from and in addition to a security classification marking.

DISTRIBUTION STATEMENT DEFINITIONS:

1. DISTRIBUTION STATEMENT A. Approved for public release, distribution is unlimited.

2. DISTRIBUTION STATEMENT B Distribution authorized to Department of Defense (DoD) and U.S.

DoD contractors only. Other requests for this document shall be referred to FRCSE Counsel via Process Engineer and the Contracting Office.