CDRL - F004-Work Authorization Form.docx
DOCX document 27 KB Posted
- Solicitation number
- N5523623R0003
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Text version
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: |
| 0002 |
| F |
| TDP |
| TM _____ |
| OTHER MGMT |
| D. SYSTEM/ITEM |
| E. CONTRACT/PR NO. |
| F. CONTRACTOR |
| PIPE LAGGING SERVICES |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| F004 |
| WORK AUTHORIZATION FORM |
| N/A |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
TOTAL PRICE
| DI-MGMT-81912 |
| SEE BLOCK 16 |
| SEE BLOCK 16 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10. FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| ASREQ |
| SEE BLK 16 |
| a. ADDRESSEE |
| b. COPIES |
| 8. APP CODE |
| D* |
| 11. AS OF DATE |
| 13. DATE IF SUBSEQUENT SUBM. |
| Draft |
| Final |
N/A
| 0 |
| SEE BLK 16 |
| Reg |
| Repro |
| 16. REMARKS |
| SWRMC CODE 300AB (SBS) |
| 0 |
| 2 |
| 0 |
BLOCK 5. PARAGRAPHS C.1.1, C.3.4, C.3.5, AND C.16.1
BLOCK 6: SWRMC CODE 300AB, SWRMC CODE 350, AND SHIP'S WAF PROGRAM COORDINATOR.
BLOCK 7: ELECTRONIC COPIES SHALL BE DELIVERED VIA E-MAIL AND HARD COPIES SHALL BE DELIVERED IN PERSON
BLOCK 9: DISTRIBUTION STATEMENT D: DISTRIBUTION AUTHORIZED TO DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY (OPERATIONAL USE) (22 MAY 2013). OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED TO COMMANDER, SOUTHWEST REGIONAL MAINTENANCE CENTER CODE 400, NAVAL BASE SAN DIEGO, 3755 BRINSER STREET SUITE 1, SAN DIEGO CA 92136.
BLOCKS 10, 11, 12, AND 13: THE WORK AUTHORIZATION FORM (WAF) SHALL BE AUTHORIZED IN ACCORDANCE WITH THE THE SHIPS WAF PROGRAM, PARAGRAPH C.3.3 OF THE STATEMENT OF WORK, AND PRIOR TO THE START OF ANY PRODUCTIVE WORK. ONE (1) HARD COPY AND ONE (1) ELECTRONIC COPY OF THE WAF SHALL BE SUBMITTED TO THE SBS AT THE TIME OF BILLING/INVOICING.
BLOCK 14: MEDIA REQUIREMENT: THE WORK AUTHORIZATION FORM SHALL BE IN ADOBE ACROBAT (PDF) FORMAT.
CURRENT SWRMC CODE 300AB SHIP BUILDING SPECIALIST (SBS)
CURRENT SWRMC CODE 350 CIS COORDINATOR
SHIP'S WAF PROGRAM COORDINATOR
E-MAIL ADDRESSES SHALL BE PROVIDED UPON AWARD OF THE CONTRACT
| SWRMC CODE 350 (CIS) |
| 0 |
| 1 |
| 0 |
| SHIPS WAF COORDINATO |
| 0 |
| 1 |
| 0 |
| 15. TOTAL ▬▬▬▬► |
| 0 |
| 4 |
| 0 |
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 1 of 1 Pages
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