CDRL_Redacted.pdf

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. B. EXHIBIT C. CATEGORY:

TBD A TDP________ TM _______ OTHER QCIC

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

Fluke 732C N64267-22-P-XXXX TBD

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

GROUP

A001 CALIBRATION CERTIFICATION Calibration Report with Data

II

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

DI-QCIC-80798C

(See Block 16)

SOW Paragraph: 5.1.2 (See Block 16)

NAWCAD BL31400 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF F RST

SUBMISSION

14. DISTR BUTION

LT ASGEN

(See Block 16)

(See Block 16) (See Block 16)

A b. COPIES

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

SUBMISSION

a. ADDRESSEE Final

A N/A N/A Draft Reg. Repro

16. REMARKS 1 1

Block 4/5: DI-QCIC-80798C and SOW paragraph 5.1.2 shall be used as guidance and are provided for reference. Information items in DI-QCIC-80798B that are not relevant to the procured unit do not need to be included in format. Actual calibration data should be contained in the calibration report related to the certificate.

Block 8: Calibration Report (CDRL A001 subtitle) requires government approval.

The contractor shall provide a preliminary draft of the Calibration Report of data to the Government for review, comment, and approval of the format no later than (NLT) 60 calendar days prior to initial operating capability (IOC) for each system.

IOC shall be defined as the delivery date of the initial order of system(s).

Government will provide the contractor with approval/disapproval of format including comments within 15 days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to IOC for first system.

Block 10: Frequency of Calibration Report shall be generated for each system installed.

Block 12: Date of first submission shall be no later than (NLT) 60 calendar days prior to initial operating capability (IOC) of the first system procured.

Block 13: Date of subsequent submissions: N/A

Block 14: Submission in contractor format is acceptable. Electronic format is preferred if in a widely available commercial document format such as MS-Excel or MS Word. Electronic submission of data is also accepted on CD-ROM. Quantity and copies shall be provided in accordance with (IAW) CDRL distribution (Block 14). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: This CDRL refers only to the format of the Calibration Report printed by the calibration standards, it is not intended that the contractor run actual US Navy workload for calibration.

1 1 0

Copies with each unit delivered

0 1 0

15. TOTAL 3 4 0

G. PREPARED BY

H. DATE I. APPROVED BY J. DATE

P. Brannick, NAWCAD BL31400 26 Jan 2022 DD Form 1423-1 JUN 90 Previous editions are obsolete. Page 1 of 2 Pages

DD FORM 1423 (CDRL) Supplemental

BLOCK 14 ENTRY COMPLETE ADDRESS

Page 2 of 2 Pages

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. B. EXHIBIT C. CATEGORY:

TBD A TDP________ TM _______ OTHER QCIC

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

Fluke 742A1 N64267-22-P-XXXX TBD

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

GROUP

A001 CALIBRATION CERTIFICATION Calibration Report with Data

II

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

DI-QCIC-80798C

(See Block 16)

SOW Paragraph: 5.1.2 (See Block 16)

NAWCAD BL31400 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF F RST

SUBMISSION

14. DISTR BUTION

LT ASGEN

(See Block 16)

(See Block 16) (See Block 16)

A b. COPIES

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

SUBMISSION

a. ADDRESSEE Final

A N/A N/A Draft Reg. Repro

16. REMARKS 1 1

Block 4/5: DI-QCIC-80798C and SOW paragraph 5.1.2 shall be used as guidance and are provided for reference. Information items in DI-QCIC-80798B that are not relevant to the procured unit do not need to be included in format. Actual calibration data should be contained in the calibration report related to the certificate.

Block 8: Calibration Report (CDRL A001 subtitle) requires government approval.

The contractor shall provide a preliminary draft of the Calibration Report of data to the Government for review, comment, and approval of the format no later than (NLT) 60 calendar days prior to initial operating capability (IOC) for each system.

IOC shall be defined as the delivery date of the initial order of system(s).

Government will provide the contractor with approval/disapproval of format including comments within 15 days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to IOC for first system.

Block 10: Frequency of Calibration Report shall be generated for each system installed.

Block 12: Date of first submission shall be no later than (NLT) 60 calendar days prior to initial operating capability (IOC) of the first system procured.

Block 13: Date of subsequent submissions: N/A

Block 14: Submission in contractor format is acceptable. Electronic format is preferred if in a widely available commercial document format such as MS-Excel or MS Word. Electronic submission of data is also accepted on CD-ROM. Quantity and copies shall be provided in accordance with (IAW) CDRL distribution (Block 14). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: This CDRL refers only to the format of the Calibration Report printed by

, NAWCAD BL31400 26 Jan 2022

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD A TDP________ TM _______ OTHER QCIC

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

Fluke 742A10K N54267-22-P-XXXX TBD

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

GROUP

A001 CALIBRATION CERTIFICATION Calibration Report with Data

II

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

DI-QCIC-80798C

(See Block 16)

SOW Paragraph: 5.1.2 (See Block 16)

NAWCAD BL31400 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF F RST

SUBMISSION

14. DISTR BUTION

LT ASGEN

(See Block 16)

(See Block 16) (See Block 16)

A b. COPIES

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

SUBMISSION

a. ADDRESSEE Final

A N/A N/A Draft Reg. Repro

16. REMARKS 1 1

Block 4/5: DI-QCIC-80798C and SOW paragraph 5.1.2 shall be used as guidance and are provided for reference. Information items in DI-QCIC-80798B that are not relevant to the procured unit do not need to be included in format. Actual calibration data should be contained in the calibration report related to the certificate.

Block 8: Calibration Report (CDRL A001 subtitle) requires government approval.

The contractor shall provide a preliminary draft of the Calibration Report of data to the Government for review, comment, and approval of the format no later than (NLT) 60 calendar days prior to initial operating capability (IOC) for each system.

IOC shall be defined as the delivery date of the initial order of system(s).

Government will provide the contractor with approval/disapproval of format including comments within 15 days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to IOC for first system.

Block 10: Frequency of Calibration Report shall be generated for each system installed.

Block 12: Date of first submission shall be no later than (NLT) 60 calendar days prior to initial operating capability (IOC) of the first system procured.

Block 13: Date of subsequent submissions: N/A

Block 14: Submission in contractor format is acceptable. Electronic format is preferred if in a widely available commercial document format such as MS-Excel or MS Word. Electronic submission of data is also accepted on CD-ROM. Quantity and copies shall be provided in accordance with (IAW) CDRL distribution (Block 14). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: This CDRL refers only to the format of the Calibration Report printed by

BL31400 26 Jan 2022

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD A TDP________ TM _______ OTHER QCIC

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

Fluke 2563 N64267-22-P-XXXX TBD

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

GROUP

A001 CALIBRATION CERTIFICATION Calibration Report with Data

II

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

DI-QCIC-80798C

(See Block 16)

SOW Paragraph: 5.1.2 (See Block 16)

NAWCAD BL31400 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF F RST

SUBMISSION

14. DISTR BUTION

LT ASGEN

(See Block 16)

(See Block 16) (See Block 16)

A b. COPIES

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

SUBMISSION

a. ADDRESSEE Final

A N/A N/A Draft Reg. Repro

16. REMARKS 1 1

Block 4/5: DI-QCIC-80798C and SOW paragraph 5.1.2 shall be used as guidance and are provided for reference. Information items in DI-QCIC-80798B that are not relevant to the procured unit do not need to be included in format. Actual calibration data should be contained in the calibration report related to the certificate.

Block 8: Calibration Report (CDRL A001 subtitle) requires government approval.

The contractor shall provide a preliminary draft of the Calibration Report of data to the Government for review, comment, and approval of the format no later than (NLT) 60 calendar days prior to initial operating capability (IOC) for each system.

IOC shall be defined as the delivery date of the initial order of system(s).

Government will provide the contractor with approval/disapproval of format including comments within 15 days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to IOC for first system.

Block 10: Frequency of Calibration Report shall be generated for each system installed.

Block 12: Date of first submission shall be no later than (NLT) 60 calendar days prior to initial operating capability (IOC) of the first system procured.

Block 13: Date of subsequent submissions: N/A

Block 14: Submission in contractor format is acceptable. Electronic format is preferred if in a widely available commercial document format such as MS-Excel or MS Word. Electronic submission of data is also accepted on CD-ROM. Quantity and copies shall be provided in accordance with (IAW) CDRL distribution (Block 14). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: This CDRL refers only to the format of the Calibration Report printed by

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD A TDP________ TM _______ OTHER QCIC

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

Fluke 3560 N64267-22-P-XXXX TBD

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

GROUP

A001 CALIBRATION CERTIFICATION Calibration Report with Data

II

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

DI-QCIC-80798C

(See Block 16)

SOW Paragraph: 5.1.2 (See Block 16)

NAWCAD BL31400 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF F RST

SUBMISSION

14. DISTR BUTION

LT ASGEN

(See Block 16)

(See Block 16) (See Block 16)

A b. COPIES

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

SUBMISSION

a. ADDRESSEE Final

A N/A N/A Draft Reg. Repro

16. REMARKS 1 1

Block 4/5: DI-QCIC-80798C and SOW paragraph 5.1.2 shall be used as guidance and are provided for reference. Information items in DI-QCIC-80798B that are not relevant to the procured unit do not need to be included in format. Actual calibration data should be contained in the calibration report related to the certificate.

Block 8: Calibration Report (CDRL A001 subtitle) requires government approval.

The contractor shall provide a preliminary draft of the Calibration Report of data to the Government for review, comment, and approval of the format no later than (NLT) 60 calendar days prior to initial operating capability (IOC) for each system.

IOC shall be defined as the delivery date of the initial order of system(s).

Government will provide the contractor with approval/disapproval of format including comments within 15 days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to IOC for first system.

Block 10: Frequency of Calibration Report shall be generated for each system installed.

Block 12: Date of first submission shall be no later than (NLT) 60 calendar days prior to initial operating capability (IOC) of the first system procured.

Block 13: Date of subsequent submissions: N/A

Block 14: Submission in contractor format is acceptable. Electronic format is preferred if in a widely available commercial document format such as MS-Excel or MS Word. Electronic submission of data is also accepted on CD-ROM. Quantity and copies shall be provided in accordance with (IAW) CDRL distribution (Block 14). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: This CDRL refers only to the format of the Calibration Report printed by

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD A TDP________ TM _______ OTHER QCIC

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

Fluke A40B-001MA N64267-22-P-XXXX TBD

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

GROUP

A001 CALIBRATION CERTIFICATION Calibration Report with Data

II

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

DI-QCIC-80798C

(See Block 16)

SOW Paragraph: 5.1.2 (See Block 16)

NAWCAD BL31400 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF F RST

SUBMISSION

14. DISTR BUTION

LT ASGEN

(See Block 16)

(See Block 16) (See Block 16)

A b. COPIES

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

SUBMISSION

a. ADDRESSEE Final

A N/A N/A Draft Reg. Repro

16. REMARKS 1 1

Block 4/5: DI-QCIC-80798C and SOW paragraph 5.1.2 shall be used as guidance and are provided for reference. Information items in DI-QCIC-80798B that are not relevant to the procured unit do not need to be included in format. Actual calibration data should be contained in the calibration report related to the certificate.

Block 8: Calibration Report (CDRL A001 subtitle) requires government approval.

The contractor shall provide a preliminary draft of the Calibration Report of data to the Government for review, comment, and approval of the format no later than (NLT) 60 calendar days prior to initial operating capability (IOC) for each system.

IOC shall be defined as the delivery date of the initial order of system(s).

Government will provide the contractor with approval/disapproval of format including comments within 15 days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to IOC for first system.

Block 10: Frequency of Calibration Report shall be generated for each system installed.

Block 12: Date of first submission shall be no later than (NLT) 60 calendar days prior to initial operating capability (IOC) of the first system procured.

Block 13: Date of subsequent submissions: N/A

Block 14: Submission in contractor format is acceptable. Electronic format is preferred if in a widely available commercial document format such as MS-Excel or MS Word. Electronic submission of data is also accepted on CD-ROM. Quantity and copies shall be provided in accordance with (IAW) CDRL distribution (Block 14). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: This CDRL refers only to the format of the Calibration Report printed by

, NAWCAD BL31400 26 Jan 20222

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD A TDP________ TM _______ OTHER QCIC

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

Fluke A40B-10A N64267-22-P-XXXX TBD

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

GROUP

A001 CALIBRATION CERTIFICATION Calibration Report with Data

II

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

DI-QCIC-80798C

(See Block 16)

SOW Paragraph: 5.1.2 (See Block 16)

NAWCAD BL31400 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF F RST

SUBMISSION

14. DISTR BUTION

LT ASGEN

(See Block 16)

(See Block 16) (See Block 16)

A b. COPIES

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

SUBMISSION

a. ADDRESSEE Final

A N/A N/A Draft Reg. Repro

16. REMARKS 1 1

Block 4/5: DI-QCIC-80798C and SOW paragraph 5.1.2 shall be used as guidance and are provided for reference. Information items in DI-QCIC-80798B that are not relevant to the procured unit do not need to be included in format. Actual calibration data should be contained in the calibration report related to the certificate.

Block 8: Calibration Report (CDRL A001 subtitle) requires government approval.

The contractor shall provide a preliminary draft of the Calibration Report of data to the Government for review, comment, and approval of the format no later than (NLT) 60 calendar days prior to initial operating capability (IOC) for each system.

IOC shall be defined as the delivery date of the initial order of system(s).

Government will provide the contractor with approval/disapproval of format including comments within 15 days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to IOC for first system.

Block 10: Frequency of Calibration Report shall be generated for each system installed.

Block 12: Date of first submission shall be no later than (NLT) 60 calendar days prior to initial operating capability (IOC) of the first system procured.

Block 13: Date of subsequent submissions: N/A

Block 14: Submission in contractor format is acceptable. Electronic format is preferred if in a widely available commercial document format such as MS-Excel or MS Word. Electronic submission of data is also accepted on CD-ROM. Quantity and copies shall be provided in accordance with (IAW) CDRL distribution (Block 14). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: This CDRL refers only to the format of the Calibration Report printed by

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD A TDP________ TM _______ OTHER QCIC

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

Fluke A40B-100A N64267-22-P-XXXX TBD

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

GROUP

A001 CALIBRATION CERTIFICATION Calibration Report with Data

II

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

DI-QCIC-80798C

(See Block 16)

SOW Paragraph: 5.1.2 (See Block 16)

NAWCAD BL31400 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF F RST

SUBMISSION

14. DISTR BUTION

LT ASGEN

(See Block 16)

(See Block 16) (See Block 16)

A b. COPIES

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

SUBMISSION

a. ADDRESSEE Final

A N/A N/A Draft Reg. Repro

16. REMARKS 1 1

Block 4/5: DI-QCIC-80798C and SOW paragraph 5.1.2 shall be used as guidance and are provided for reference. Information items in DI-QCIC-80798B that are not relevant to the procured unit do not need to be included in format. Actual calibration data should be contained in the calibration report related to the certificate.

Block 8: Calibration Report (CDRL A001 subtitle) requires government approval.

The contractor shall provide a preliminary draft of the Calibration Report of data to the Government for review, comment, and approval of the format no later than (NLT) 60 calendar days prior to initial operating capability (IOC) for each system.

IOC shall be defined as the delivery date of the initial order of system(s).

Government will provide the contractor with approval/disapproval of format including comments within 15 days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to IOC for first system.

Block 10: Frequency of Calibration Report shall be generated for each system installed.

Block 12: Date of first submission shall be no later than (NLT) 60 calendar days prior to initial operating capability (IOC) of the first system procured.

Block 13: Date of subsequent submissions: N/A

Block 14: Submission in contractor format is acceptable. Electronic format is preferred if in a widely available commercial document format such as MS-Excel or MS Word. Electronic submission of data is also accepted on CD-ROM. Quantity and copies shall be provided in accordance with (IAW) CDRL distribution (Block 14). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: This CDRL refers only to the format of the Calibration Report printed by

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD T TDP________ TM TMSS OTHER _________

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

Fluke 732C N64267-22-P-XXXX TBD

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

T001 Commercial Off-The-Shelf (COTS) Manuals and Associated Supplemental Data

Operator/Service Manual

II

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

DI-TMSS-80527C

(See Block 16)

SOW Paragraph 5.1.1 (See Block 16)

NAWCAD BL31400 TOTAL PRICE

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

SUBMISSION

14 DISTRIBUTION

XX A

(See Block 16)

(See Block 16)

(See Block 16) (See Block 16) b COPIES

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

SUBMISSION

a ADDRESSEE Final

A

N/A (See Block 16)

Draft Reg. Rep ro

16 REMARKS 1 1 0

Block 4/5: DI-TMSS-80527C shall be used as guidance and is provided for reference. SOW paragraph 5.1.1 is mandatory to this requirement.

Block 8: Operator/Service Manual(s) (CDRL T001 subtitle) requires government approval. Contractor shall provide a preliminary draft to the government for review, comment, and approval no later than (NLT) 30 calendar days prior to acceptance testing. Government will provide the contractor with comments NLT 15 calendar days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to initial operating capability (IOC) of each system to addressees in accordance with (IAW) CDRL T001 distribution (Block 14a).

Block 9: DISTRIBUTION STATEMENT A. Public Distribution Authorized.

Block 10/12/13: Submissions of Operator/Service Manual(s) shall be provided with each new system being delivered.

Block 14: Submission in contractor format is acceptable. Electronic format is desired and acceptable if in MS-Excel or MS Word. Electronic submission of data shall also be on CD-ROM and/or DvD media. Qty. (1) Operator/Service Manual shall be shipped with each Calibration Standard installed. Quantity and copies shall be provided IAW CDRL T001 distribution (Block 14a). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: The US government shall have limited technical data rights for all technical manuals and documents furnished with the procured commercial items, for the purpose of Government use only in duplicating or posting technical documentation to limited access web sites for use by US Government Personnel and Contractors engaged in maintenance, calibration or related logistics activities associated with the procured commercial items in accordance with DFARS 252.227-7015 Technical Data--Commercial Items.

NAWCAD BL31400 22 Jan 2022

1077/183

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD T TDP________ TM TMSS OTHER _________

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

Fluke 742A1 N64267-22-P-XXXX TBD

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

T001 Commercial Off-The-Shelf (COTS) Manuals and Associated Supplemental Data

Operator/Service Manual

II

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

DI-TMSS-80527C

(See Block 16)

SOW Paragraph 5.1.1

14 DISTRIBUTION

XX A

(See Block 16)

(See Block 16)

(See Block 16) (See Block 16) b COPIES

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

SUBMISSION

a ADDRESSEE Final

A

16 REMARKS 1 1 0

Block 4/5: DI-TMSS-80527C shall be used as guidance and is provided for reference. SOW paragraph 5.1.1 is mandatory to this requirement.

Block 8: Operator/Service Manual(s) (CDRL T001 subtitle) requires government approval. Contractor shall provide a preliminary draft to the government for review, comment, and approval no later than (NLT) 30 calendar days prior to acceptance testing. Government will provide the contractor with comments NLT 15 calendar days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to initial operating capability (IOC) of each system to addressees in accordance with (IAW) CDRL T001 distribution (Block 14a).

Block 9: DISTRIBUTION STATEMENTA. Public Distribution Authorized.

Block 10/12/13: Submissions of Operator/Service Manual(s) shall be provided with each new system being delivered.

Block 14: Submission in contractor format is acceptable. Electronic format is desired and acceptable if in MS-Excel or MS Word. Electronic submission of data shall also be on CD-ROM and/or DvD media. Qty. (1) Operator/Service Manual shall be shipped with each Calibration Standard installed. Quantity and copies shall be provided IAW CDRL T001 distribution (Block 14a). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: The US government shall have limited technical data rights for all technical manuals and documents furnished with the procured commercial items, for the purpose of Government use only in duplicating or posting technical documentation to limited access web sites for use by US Government Personnel and Contractors engaged in maintenance, calibration or related logistics activities associated with the procured commercial items

NAWCAD BL31400 26 Jan 2022

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD T TDP________ TM TMSS OTHER _________

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

Fluke 742A10K N64267-22-P-XXXX TBD

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

T001 Commercial Off-The-Shelf (COTS) Manuals and Associated Supplemental Data

Operator/Service Manual

II

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

DI-TMSS-80527C

(See Block 16)

SOW Paragraph 5.1.1

14 DISTRIBUTION

XX A

(See Block 16)

(See Block 16)

(See Block 16) (See Block 16) b COPIES

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

SUBMISSION

a ADDRESSEE Final

A

16 REMARKS 1 1 0

Block 4/5: DI-TMSS-80527C shall be used as guidance and is provided for reference. SOW paragraph 5.1.1 is mandatory to this requirement.

Block 8: Operator/Service Manual(s) (CDRL T001 subtitle) requires government approval. Contractor shall provide a preliminary draft to the government for review, comment, and approval no later than (NLT) 30 calendar days prior to acceptance testing. Government will provide the contractor with comments NLT 15 calendar days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to initial operating capability (IOC) of each system to addressees in accordance with (IAW) CDRL T001 distribution (Block 14a).

Block 9: DISTRIBUTION STATEMENT A. Public Distribution Authorized.

Block 10/12/13: Submissions of Operator/Service Manual(s) shall be provided with each new system being delivered.

Block 14: Submission in contractor format is acceptable. Electronic format is desired and acceptable if in MS-Excel or MS Word. Electronic submission of data shall also be on CD-ROM and/or DvD media. Qty. (1) Operator/Service Manual shall be shipped with each Calibration Standard installed. Quantity and copies shall be provided IAW CDRL T001 distribution (Block 14a). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: The US government shall have limited technical data rights for all technical manuals and documents furnished with the procured commercial items, for the purpose of Government use only in duplicating or posting technical documentation to limited access web sites for use by US Government Personnel and Contractors engaged in maintenance, calibration or related logistics activities associated with the procured commercial items

NAWCAD BL31400 26 Jan 2022

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD T TDP________ TM TMSS OTHER _________

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

Fluke 2563 N64267-22-P-XXXX TBD

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

T001 Commercial Off-The-Shelf (COTS) Manuals and Associated Supplemental Data

Operator/Service Manual

II

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

DI-TMSS-80527C

(See Block 16)

SOW Paragraph 5.1.1

14 DISTRIBUTION

XX A

(See Block 16)

(See Block 16)

(See Block 16) (See Block 16) b COPIES

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

SUBMISSION

a ADDRESSEE Final

A

16 REMARKS 1 1 0

Block 4/5: DI-TMSS-80527C shall be used as guidance and is provided for reference. SOW paragraph 5.1.1 is mandatory to this requirement.

Block 8: Operator/Service Manual(s) (CDRL T001 subtitle) requires government approval. Contractor shall provide a preliminary draft to the government for review, comment, and approval no later than (NLT) 30 calendar days prior to acceptance testing. Government will provide the contractor with comments NLT 15 calendar days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to initial operating capability (IOC) of each system to addressees in accordance with (IAW) CDRL T001 distribution (Block 14a).

Block 9: DISTRIBUTION STATEMENT A. Public Distribution Authorized.

Block 10/12/13: Submissions of Operator/Service Manual(s) shall be provided with each new system being delivered.

Block 14: Submission in contractor format is acceptable. Electronic format is desired and acceptable if in MS-Excel or MS Word. Electronic submission of data shall also be on CD-ROM and/or DvD media. Qty. (1) Operator/Service Manual shall be shipped with each Calibration Standard installed. Quantity and copies shall be provided IAW CDRL T001 distribution (Block 14a). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: The US government shall have limited technical data rights for all technical manuals and documents furnished with the procured commercial items, for the purpose of Government use only in duplicating or posting technical documentation to limited access web sites for use by US Government Personnel and Contractors engaged in maintenance, calibration or related logistics activities associated with the procured commercial items

NAWCAD BL31400 22 Jan 2022

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD T TDP________ TM TMSS OTHER _________

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

Fluke 3560 N64267-22-P-XXXX TBD

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

T001 Commercial Off-The-Shelf (COTS) Manuals and Associated Supplemental Data

Operator/Service Manual

II

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

DI-TMSS-80527C

(See Block 16)

SOW Paragraph 5.1.1

14 DISTRIBUTION

XX A

(See Block 16)

(See Block 16)

(See Block 16) (See Block 16) b COPIES

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

SUBMISSION

a ADDRESSEE Final

A

16 REMARKS 1 1 0

Block 4/5: DI-TMSS-80527C shall be used as guidance and is provided for reference. SOW paragraph 5.1.1 is mandatory to this requirement.

Block 8: Operator/Service Manual(s) (CDRL T001 subtitle) requires government approval. Contractor shall provide a preliminary draft to the government for review, comment, and approval no later than (NLT) 30 calendar days prior to acceptance testing. Government will provide the contractor with comments NLT 15 calendar days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to initial operating capability (IOC) of each system to addressees in accordance with (IAW) CDRL T001 distribution (Block 14a).

Block 9: DISTRIBUTION STATEMENT A. Public Distribution Authorized.

Block 10/12/13: Submissions of Operator/Service Manual(s) shall be provided with each new system being delivered.

Block 14: Submission in contractor format is acceptable. Electronic format is desired and acceptable if in MS-Excel or MS Word. Electronic submission of data shall also be on CD-ROM and/or DvD media. Qty. (1) Operator/Service Manual shall be shipped with each Calibration Standard installed. Quantity and copies shall be provided IAW CDRL T001 distribution (Block 14a). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: The US government shall have limited technical data rights for all technical manuals and documents furnished with the procured commercial items, for the purpose of Government use only in duplicating or posting technical documentation to limited access web sites for use by US Government Personnel and Contractors engaged in maintenance, calibration or related logistics activities associated with the procured commercial items

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD T TDP________ TM TMSS OTHER _________

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

Fluke A40B-001MA N64267-22-P-XXXX TBD

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

T001 Commercial Off-The-Shelf (COTS) Manuals and Associated Supplemental Data

Operator/Service Manual

II

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

DI-TMSS-80527C

(See Block 16)

SOW Paragraph 5.1.1

14 DISTRIBUTION

XX A

(See Block 16)

(See Block 16)

(See Block 16) (See Block 16) b COPIES

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

SUBMISSION

a ADDRESSEE Final

A

16 REMARKS 1 1 0

Block 4/5: DI-TMSS-80527C shall be used as guidance and is provided for reference. SOW paragraph 5.1.1 is mandatory to this requirement.

Block 8: Operator/Service Manual(s) (CDRL T001 subtitle) requires government approval. Contractor shall provide a preliminary draft to the government for review, comment, and approval no later than (NLT) 30 calendar days prior to acceptance testing. Government will provide the contractor with comments NLT 15 calendar days of receipt of preliminary draft. Contractor shall provide a government approved final version with incorporated comments NLT 30 days prior to initial operating capability (IOC) of each system to addressees in accordance with (IAW) CDRL T001 distribution (Block 14a).

Block 9: DISTRIBUTION STATEMENT A. Public Distribution Authorized.

Block 10/12/13: Submissions of Operator/Service Manual(s) shall be provided with each new system being delivered.

Block 14: Submission in contractor format is acceptable. Electronic format is desired and acceptable if in MS-Excel or MS Word. Electronic submission of data shall also be on CD-ROM and/or DvD media. Qty. (1) Operator/Service Manual shall be shipped with each Calibration Standard installed. Quantity and copies shall be provided IAW CDRL T001 distribution (Block 14a). Addressee's POC information provided on CDRL supplemental page 2.

Block 16: The US government shall have limited technical data rights for all technical manuals and documents furnished with the procured commercial items, for the purpose of Government use only in duplicating or posting technical documentation to limited access web sites for use by US Government Personnel and Contractors engaged in maintenance, calibration or related logistics activities associated with the procured commercial items

BLOCK 14 ENTRY COMPLETE ADDRESS

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. B. EXHIBIT C. CATEGORY:

TBD T TDP________ TM TMSS OTHER _________

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

Fluke A40B-10A N64267-22-P-XXXX TBD

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

T001 Commercial Off-The-Shelf (COTS) Manuals and Associated Supplemental Data

Operator/Service Manual

II

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

DI-TMSS-80527C

(See Block 16)

SOW Paragraph 5.1.1

14 DISTRIBUTION

XX A

(See Block 16)

(See Block 16)

(See Block 16) (See Block 16) b COPIES

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

SUBMISSION

a ADDRESSEE Final

A

16 REMARKS 1 1 0

Block 4/5: DI-TMSS-80527C shall be used as guidance and is provided for reference.