CDRL1_REPORT.PDF.pdf

PDF 125 KB Posted Apr 3, 2020

Attached to: Repair of Components Applicable to Lightweight Airborne Recovery System (LARS)
Solicitation number: FA8524-20-R-0001
Issued by: Department of the Air Force Materiel Command Air Force Sustainment Center

View the file

Other files

File	Type	Posted
Wage_Determination.pdf	PDF	Apr 3, 2020
CAVAF.pdf	PDF	Apr 3, 2020
TRNSPDATA_REPORT.pdf	PDF	Apr 3, 2020
DD_2875.pdf	PDF	Apr 3, 2020
GFP.pdf	PDF	Apr 3, 2020
PWS.pdf	PDF	Apr 3, 2020
PKGRQMT_REPORT.pdf	PDF	Apr 3, 2020
FA8524-20-R-0001.pdf	PDF	Apr 3, 2020

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

CONTRACT DATA REQUIREMENTS LIST Form Approved OMB No. 0704-0188(1 Data Item)

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 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

TDP TM OTHER X

D. SYSTEM / ITEM

Lightweight Airborne Recovery System (LARS)

E. CONTRACT / PR NO.

FD20602000050

F. CONTRACTOR

Cubic Defense Applications

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Commercial Asset Visibility Air Force (CAV) Reporting

3. SUBTITLE

CFM End Item Reporting

4. AUTHORITY

DI-MGMT-81838

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

Performance-based Work Statement(PWS),para 4.15

6. REQUIRING OFFICE

411th SCMS GULA

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

N/A

10. FREQUENCY

See Block 16

11. AS OF DATE

SEE BLK 16

12. DATE OF FIRST

SUBMISSION

SEE BLK 16

13. DATE OF SUBSEQUENT

SUBMISSION

SEE BLK 16

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

White, James HNAME: 12 JAN 2019DATE:

NOTE: Changes to office symbols and/or e-mail addresses, when necessary shall be made by letter through the Government CO/ACO without further revision to this CDRL.

1. Block 5: Contract Reference: PWS Paragraph 4.7 and CAV AF Reporting Requirements Document

2. Block 4: All reporting shall be submitted in the English Language.

3. Blocks 10, 11, 12, 13:

a. Date of first submission shall be within 24 hours following a supply or maintenance transaction, after the contract award date.

b. Contractor reporting requirements to CAV AF shall be submitted daily and/or within 24 hours of a supply or maintenance action occurrence IAW the CAV AF Reporting Requirements Document.

c. Data shall be current within 24 hours of the last End Item maintenance occurrence

4. Blocks 7, 8, 14:

a. The contractor shall report End Item transactional data through electronic submission in CAV AF using the CAV AF website or CICA XML.

b. The contractor shall submit a DD Form 250 (Material Inspection and Receiving Report) electronically via the Internet to iRAPT (WAWF) website address: https://wawf.eb.mil, using DODAAC FA8251. MARK FOR: Address in block 14A.

c. A Letter of Transmittal shall be submitted in the month the delivery order is completed, covering all reports transmitted for that order. Submit the Letter via email; POC's will be give at time of contract award.

COORDINATORS:

SEE BLK 16 0 1 0

0 1 015. TOTAL

G. PREPARED BY

White, James H

411 SCMS / GULA

478-222-0843

H. DATE

16 DEC 2019

I. APPROVED BY

//DIGITALLY SIGNED//

WILSON.MICHELLE.L.1284839729

411 SCMS / GULAA 478-222-5167 / 472-5167

J. DATE

16 DEC 2019

Page 1 of 8DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 17 Dec 2019

PREVIOUS EDITION MAY BE USED.

A. CONTRACT LINE ITEM NO. B. EXHIBIT

C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

Lightweight Airborne Recovery System (LARS)

E. CONTRACT / PR NO.

FD20602000050

F. CONTRACTOR

Cubic Defense Applications

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

CONTRACT DEPOT MAINTENANCE PRODUCTION

REPORT

3. SUBTITLE

Production Report

4. AUTHORITY

DI-PSSS-81995

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

Performance-based Work Statement(PWS) para. 4.18

6. REQUIRING OFFICE

411th SCMS/GULAA

7. DD 250 REQ

8. APP CODE

See Block 16

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

MTHLY

11. AS OF DATE

SEE BLOCK 16

12. DATE OF FIRST

SUBMISSION

SEE BLOCK 16

13. DATE OF SUBSEQUENT

SUBMISSION

SEE BLOCK 16

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Light, Anthony PNAME: 24 JUL 2019DATE:

BLK 4: The Data Item Description (DID) contains the format, content and preparation instructions for the data product generated by the specific and discrete task requirement explanations at http://quicksearch.dla.mil/for content requirements.

BLK 7: WAWF E-DD FORM 250 shall be required for separately priced data. E-DD FORM 250 shall be submitted to Program Manager (PM) FA8524. Program Manager designated email to be given at time of contract award.

BLK 8: Approval (written) is not required. However, the data item will be reviewed and accepted/rejected, based on its conforming to the requirements of the DID, and within the review time specified in BLK 6.

BLK 10-13: Report shall be submitted NLT the 10th calendar day after the end of the month being reported.

BLK 14: EMAIL electronic Contract Depot Maintenance Production Report to the Production Management Specialist (PMS) and Program Manager (PM). Points of contact will be provided to the contractor at contract award. Submit digital copy in a Microsoft Office compatible format or Adobe PDF for all report.

COORDINATORS:

Submission by email to Program Manager and Production Management Specialist. POC's will be provided to the Contractor at contract award.

0 1 0

0 1 015. TOTAL

G. PREPARED BY

White, James H

411 SCMS / GULA

478-222-0843

H. DATE

16 DEC 2019

I. APPROVED BY

//DIGITALLY SIGNED//

WILSON.MICHELLE.L.1284839729

411 SCMS / GULAA 478-222-5167 / 472-5167

J. DATE

16 DEC 2019

Page 2 of 8DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 17 Dec 2019

A. CONTRACT LINE ITEM NO. B. EXHIBIT

C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

Lightweight Airborne Recovery System (LARS)

E. CONTRACT / PR NO.

FD20602000050

F. CONTRACTOR

Cubic Defense Applications

1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM

Counterfeit Prevention Plan

3. SUBTITLE

CPP

4. AUTHORITY

DI-MISC-81832

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

Performance-based Work Statement (PWS) para 4.14

6. REQUIRING OFFICE

411 SCMS/GULAA

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

See Block 16

11. AS OF DATE

See Block 16

12. DATE OF FIRST

SUBMISSION

See Block 16

13. DATE OF SUBSEQUENT

SUBMISSION

See Block 16

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Light, Anthony PNAME: 24 JUL 2019DATE:

BLK 4: The Data Item Description contains the format and content preparation instructions for the data product generated by the specific and discrete task requirements delineated in the statement of work. See Data Item Description at http://quicksearch.dla.mil/ for content requirements.

BLK 7: WAWF E-DD FORM 250 shall be required for separately priced data. E-DD FORM 250 shall be submitted to FA8524 Program Manager (PM) for acceptance.

BLK 9: "C" Distribution authorized to U.S. Government Agencies and their contractors (Administrative or Operational use) (28 April 16). Other requests shall be referred to the contract management team, AFSC/PZAAA, 460 Richard Ray Blvd, Suite 221, Robins AFB, GA 31098.

BLKS 10-13: Draft Counterfeit Prevention Plan shall be submitted electronically within 30 workdays after contract award. Contractor shall provide quarterly updates as necessary until final at completion of program. The Government will have 15 workdays to approve, submit comments, or disapprove all submissions. The contractor shall have 15 workdays to resubmit report if changes were deemed necessary by the Government.

BLK 14: EMAIL electronic Counterfeit Prevention Plan to the Procuring Contract Officer (PCO) AFSC/PZAAA, Program Manager (PM) 411 SCMS/GULAA and Engineer AFLCMC/WIUEC. CDRL Distribution Points of Contact will be provided to the Contractor at Contract Award. Submit digital copy in a Microsoft Office compatible format or Adobe Portable Document Format for all reports.

White, James HNAME: 23 MAY 2017DATE:

BLK 7: WAWF E-DD FORM 250 shall be required for separately priced data. E-DD FORM 250 shall be submitted to FA8524 Program Manager (PM) for acceptance.

COORDINATORS:

Submission by email to AFSC/PCO, Program Manager, and Engineer. POC's will be provided to the Contractor at contract award.

1 1 0

1 1 015. TOTAL

Page 3 of 8DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 17 Dec 2019

G. PREPARED BY

White, James H

411 SCMS / GULA

478-222-0843

H. DATE

16 DEC 2019

I. APPROVED BY

//DIGITALLY SIGNED//

WILSON.MICHELLE.L.1284839729

411 SCMS / GULAA 478-222-5167 / 472-5167

J. DATE

16 DEC 2019

A. CONTRACT LINE ITEM NO. B. EXHIBIT

C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

Lightweight Airborne Recovery System (LARS)

E. CONTRACT / PR NO.

FD20602000050

F. CONTRACTOR

Cubic Defense Applications

1. DATA ITEM NO.

A004

2. TITLE OF DATA ITEM

ITEM UNIQUE IDENTIFICATION (IUID) MARKING

PLAN

3. SUBTITLE

IUID

4. AUTHORITY

DI-MGMT-81803

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

Performance-based Work Statement(PWS) para. 4.10.4

6. REQUIRING OFFICE

AFLCMC/WIUEA

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

See Block 16

11. AS OF DATE

SEE BLK 16

12. DATE OF FIRST

SUBMISSION

SEE BLK 16

13. DATE OF SUBSEQUENT

SUBMISSION

SEE BLK 16

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Light, Anthony PNAME: 24 JUL 2019DATE:

Block 7: The Contractor shall submit the Receiving Report upon final Government acceptance through Wide Area Workflow to collectively account for data previously submitted by Letter of Transmittal.

Block 8: Approval (written) is not required. However, the data item will be reviewed and accepted/rejected, based on its conforming to the requirements of the DID, and within the review time specified in Block 16, items 10-12.

Block 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only. Other requests shall be referred to the contract management team, AFSC/PZAAA, 460 Richard Ray Blvd, Suite 221, Robins AFB GA 31098.

Block 10-12: Contractor shall submit an IUID Marking Plan, to the Engineer, AFLCMC/WIUEA, within 10 working days after contract award. Written Government acceptance/comments/rejection will be within 10 working days after receipt of Plan from the contractor. Contractor final submission shall be submitted within 10 working days of receiving Government comments. Acceptance by the Government is required prior to formal distribution.

Block 13: If, during the performance of this contract, changes to the IUID Marking Plan are required, submit the revised IUID Marking Plan to Engineering Office, AFLCMC/WIUEA, 235 Byron St, Suite 19A, Robins AFB GA 31098.

Procedures identified for blocks 8 & 10-12 will apply.

Block 14: EMAIL Report to the Procuring Contract Officer (PCO), DCMA/ACO, Program Manager and Engineer.

CDRL Distribution Points of Contact will be provided to the Contractor at Contract Award

COORDINATORS:

Submission by email to AFSC/PCO, Program Manager, and Engineer. POC's will be provided to the Contractor at contract award.

1 1 0

1 1 015. TOTAL

G. PREPARED BY

White, James H

411 SCMS / GULA

478-222-0843

H. DATE

16 DEC 2019

I. APPROVED BY

//DIGITALLY SIGNED//

WILSON.MICHELLE.L.1284839729

411 SCMS / GULAA 478-222-5167 / 472-5167

J. DATE

16 DEC 2019

Page 4 of 8DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 17 Dec 2019

A. CONTRACT LINE ITEM NO. B. EXHIBIT

C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

Lightweight Airborne Recovery System (LARS)

E. CONTRACT / PR NO.

FD20602000050

F. CONTRACTOR

Cubic Defense Applications

1. DATA ITEM NO.

A005

2. TITLE OF DATA ITEM

ITEM UNIQUE IDENTIFICATION MARKING

ACTIVITY, VALIDATION AND VERIFICATION

REPORT

3. SUBTITLE

IUID MARKING ACTIVITY

4. AUTHORITY

DI-MGMT-81804

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

Performance-based Work Statement(PWS) para.4.10.5

6. REQUIRING OFFICE

AFLCMC/WIUEA

7. DD 250 REQ

8. APP CODE

See Block 16

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

QRTLY

11. AS OF DATE

SEE BLK 16

12. DATE OF FIRST

SUBMISSION

SEE BLK 16

13. DATE OF SUBSEQUENT

SUBMISSION

SEE BLK 16

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Light, Anthony PNAME: 24 JUL 2019DATE:

Block 7: The Contractor shall submit a Receiving Report upon final Government acceptance through Wide Area Workflow (WAWF) to collectively account for data previously submitted by Letter of Transmittal.

Block 8, 10-12: Contractor shall submit an IUID marking Activity and Verification Report, to the Engineer, AFLCMC/WIUEC every three months. Written Government acceptance/comments/rejection will be within 10 working days after receipt of Report from the Contractor. Contractor final submission shall be submitted within 10 working days of receiving Government comments. Acceptance by the Government is required prior to formal distribution.

Block 9: Distribution authorized to the Department of Defense and U.S. DoD Contractors only. Other requests shall be referred to the contract management team, AFSC/PZAAA, 460 Richard Ray Blvd, Suite 221, Robins AFB GA 31098.

Block 13: If, during the performance of this contract, changes to the IUID Marking Plan are required, submit the revised IUID Marking Plan to Engineering Office, AFLCMC/WIUEC, 235 Byron St, Suite 19A, Robins AFB GA 31098.

Procedures identified for blocks8, 10-12 will apply.

Block 14: EMAIL Report to the Procuring Contract Office, DCMA/ACO, Program Manager and Engineer, CDRL Distribution Points of Contact will be provided to the Contractor at Contract Award.

COORDINATORS:

Submission by email to AFSC/PCO, Program Manager, and Engineer. POC's will be provided to the Contractor at contract award.

1 1 0

1 1 015. TOTAL

G. PREPARED BY

White, James H

411 SCMS / GULA

478-222-0843

H. DATE

16 DEC 2019

I. APPROVED BY

//DIGITALLY SIGNED//

WILSON.MICHELLE.L.1284839729

411 SCMS / GULAA 478-222-5167 / 472-5167

J. DATE

16 DEC 2019

Page 5 of 8DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 17 Dec 2019

A. CONTRACT LINE ITEM NO. B. EXHIBIT

C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

Lightweight Airborne Recovery System (LARS)

E. CONTRACT / PR NO.

FD20602000050

F. CONTRACTOR

Cubic Defense Applications

1. DATA ITEM NO.

A006

2. TITLE OF DATA ITEM

QUALITY PROGRAM PLAN (QPP)

3. SUBTITLE

QUALITY PROGRAM PLAN

4. AUTHORITY

DI-QCIC-81722

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

PWS para 5.9

6. REQUIRING OFFICE

411th SCMS/GULAA

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

1 XTIME

11. AS OF DATE

See block 16

12. DATE OF FIRST

SUBMISSION

See block 16

13. DATE OF SUBSEQUENT

SUBMISSION

See block 16

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Light, Anthony PNAME: 24 JUL 2019DATE:

See Data Item Description at http://quicksearch.dla.mil/ for content requirements.

Block 4: Contractor format acceptable.

Block 7: Submit final with DD Form 250 to account for all previously submitted via WAWF for acceptance under

DODAAC: FA8524.

BLK 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative and Operational use. Other requests for thisdocument shall be referred to the Program Block 10, 11, 12, 13: One submission is required for contract. The government will have 30 calendar days to correct and resubmit.

Block 14: Submissions shall be IAW CDRL instructions and PWS

COORDINATORS:

411th SCMS/GULAA Program Manager (PM) Provided on Contract Award

1 1 0

1 1 015. TOTAL

G. PREPARED BY

White, James H

411 SCMS / GULA

478-222-0843

H. DATE

16 DEC 2019

I. APPROVED BY

//DIGITALLY SIGNED//

WILSON.MICHELLE.L.1284839729

411 SCMS / GULAA 478-222-5167 / 472-5167

J. DATE

16 DEC 2019

Page 6 of 8DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 17 Dec 2019

A. CONTRACT LINE ITEM NO. B. EXHIBIT

C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

Lightweight Airborne Recovery System (LARS)

E. CONTRACT / PR NO.

FD20602000050

F. CONTRACTOR

Cubic Defense Applications

1. DATA ITEM NO.

A007

2. TITLE OF DATA ITEM

Maintenance Data Collection Record (MDCR)

3. SUBTITLE

AFTO Form 349

4. AUTHORITY

DI-MISC-82003

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

PWS para 5.10

6. REQUIRING OFFICE

411th SCMS/GULA

7. DD 250 REQ

8. APP CODE

N/A

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

QRTLY

11. AS OF DATE

See Block 16

12. DATE OF FIRST

SUBMISSION

See Block 16

13. DATE OF SUBSEQUENT

SUBMISSION

See Block 16

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Light, Anthony PNAME: 24 JUL 2019DATE:

Block 4: Tailored to provide for submission of reports electronically, in contractor format, in lieu of AFTO FORM 349.

Block 7: WAWF E-DD FORM 250 shall be required for priced data. E-DD FORM 250 shall be submitted to FA8524 daniel.crosby@us.af.mil for acceptance.

Block 10-13: Report shall be submitted to arrive NLT 10th calendar day after the end of the month being reported.

Report shall include information for each item being repaired during the month. Negative reports are not required.

Block 14: EMAIL Report to Program Manager (PM) daniel.crosby@us.af.mil CDRL Distribution Points of Contact will be provided to the Contractor at Contract Award.

COORDINATORS:

Submission by email to Program Manager and Production Management Specialist. POC's will be provided to the Contractor at contract award.

0 1 0

0 1 015. TOTAL

G. PREPARED BY

White, James H

411 SCMS / GULA

478-222-0843

H. DATE

16 DEC 2019

I. APPROVED BY

//DIGITALLY SIGNED//

WILSON.MICHELLE.L.1284839729

411 SCMS / GULAA 478-222-5167 / 472-5167

J. DATE

16 DEC 2019

Page 7 of 8DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 17 Dec 2019

A. CONTRACT LINE ITEM NO. B. EXHIBIT

C. CATEGORY

TDP TM OTHER X

D. SYSTEM / ITEM

Lightweight Airborne Recovery System (LARS)

E. CONTRACT / PR NO.

FD20602000050

F. CONTRACTOR

Cubic Defense Applications

1. DATA ITEM NO.

A008

2. TITLE OF DATA ITEM

Government Property Inventory Report

3. SUBTITLE

Government Property Inventory Report

4. AUTHORITY

DI-MGMT-80441C

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

Performance Work Statement (PWS) para 5.11

6. REQUIRING OFFICE

411 SCMS/GULAA

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ANNLY

11. AS OF DATE

See Block 16

12. DATE OF FIRST

SUBMISSION

See Block 16

13. DATE OF SUBSEQUENT

SUBMISSION

See Block 16

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Light, Anthony PNAME: 24 JUL 2019DATE:

BLK 4: The data item description (DID) contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

See Data Item Description at http://quicksearch.dla.mil/ for content requirements and most current version.

BLK 7: Enter the applicable code as listed in DOD 5010.12-M, Chapter 3. (Enter LT for Letter of Transmittal if not separately priced or DD if separately priced). WAWF E-DD FORM 250 shall be required for separately priced data. E- DD FORM 250 shall be submitted to FA8524 Program Manager for acceptance.

BLK 9: "A" Approved for Public Release; distribution is unlimited.

Block 10-13: The annual physical inventory report shall be provided within seven (7) calendar days of the end of each option/ordering period for the contract. The data is representative of the Contractor's Internal Property Control System and shall be current as of the last day of the option/ordering reporting period. If requested outside of an annual cadence, the data shall be current as of the date requested.

BLK 14: EMAIL electronic Annual Physical Inventory Report t to the Production Management Specialist (PMS) and Program Manager (PM). Points of Contact will be provided to the Contractor at Contract Award. Submit digital copy in Microsoft Office Excel format for all reports.

COORDINATORS:

411 SCMS/GULAA Program Manager (PM) PM email provided on Contract Award

0 1 0

0 1 015. TOTAL

G. PREPARED BY

White, James H

411 SCMS / GULA

478-222-0843

H. DATE

16 DEC 2019

I. APPROVED BY

//DIGITALLY SIGNED//

WILSON.MICHELLE.L.1284839729

411 SCMS / GULAA 478-222-5167 / 472-5167

J. DATE

16 DEC 2019

Page 8 of 8DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 17 Dec 2019

File details come from the government source that posted it. Updated Apr 3, 2020.