CDRLS_A001-A010.pdf

PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, FEB 2001 PagesPage of

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130

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:

TDP TM OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

16. REMARKS

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

1 1

0001 A SAFT

CONSTRUCTION SERVICES TBD TBD

A001

CONTRACTOR’S SAFETY PLAN

DI-SAFT-82080 Section 00 73 01, Subsection 9 NSWC PHD CODE 1022

LT

N/A D

OTIME

N/A

SEE BLK 16

N/A

BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to the Department of Defense and U.S. DoD contractors only 18 JAN 2023. Other requests shall be referred to NSWC PHD.

BLK 12: First Submission for the Contractor’s Safety Plan will be prior to construction start date the first task order

BLK 14 &14a: Media Requirement. The report shall be delivered in Microsoft Office format (NMCI current deployed version) with E-mail notification to the following: ted.l.reed.civ@us.navy.mil (023- CS), siouzann.r.lende.civ@us.navy.mil (0231-KO), miguel.alamo4.civ@us.navy.mil (BD33-COR), forrest.w.linder.civ@us.navy.mil (CODE 1022-RG), carter.p.divine.civ@us.navy.mil (1024)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 - 19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

CODE 023-CS 1

CODE 1022-RG 1

BD33-COR 1

CODE 0231-KO 1

CODE 1024 1

N/A

Forrest Linder

LINDER.FORREST.WILLIAM.1545953788 Digitally signed by LINDER.FORREST.WILLIAM.1545953788 Date: 2023.03.24 12:28:26 -07'00'

3/24/2023 Wendy Doman

DOMAN.WENDY.JO.1070425692 Digitally signed by DOMAN.WENDY.JO.1070425692 Date: 2023.03.27 06:50:26 -07'00'

3/27/2023

(1 Data Item)

Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130

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:

TDP TM OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

16. REMARKS

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

1 1

0001 A MGMT

CONSTRUCTION SERVICES TBD TBD

A002

CONTRACTOR'S PERSONNEL ROSTER

DI-MGMT-81834A Section 00 73 01, Subsection 15 NSWC PHD CODE 1022

LT

N/A D

ASREQ

N/A

SEE BLK 16

SEE BLK 16

BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only 18 JAN 2023. Other requests shall be referred to NSWC PHD.

BLK 12: First Submission for Contractor Personnel Roster should be within 30 days after effective date of order

BLK 13: Vendor shall update as changes occur.

BLK 14 &14a: Media Requirement. The report shall be delivered in Microsoft Office format (NMCI current deployed version) with E-mail notification to the following: ted.l.reed.civ@us.navy.mil (023- CS), miguel.alamo4.civ@us.navy.mil (BD33-COR), forrest.w.linder.civ@us.navy.mil (1022- RG)siouzann.r.lende.civ@us.navy.mil (0231-KO)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 - 19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

CODE 023-CS 1

CODE 1022-RG 1

BD33-COR 1

CODE 0231-KO 1

N/A

Forrest Linder, Code 1022

LINDER.FORREST.WILLIAM.1545953788 Digitally signed by LINDER.FORREST.WILLIAM.1545953788 Date: 2023.03.24 12:52:08 -07'00'

3/24/2023 Wendy Doman

DOMAN.WENDY.JO.1070425692 Digitally signed by DOMAN.WENDY.JO.1070425692 Date: 2023.03.27 07:22:24 -07'00'

(1 Data Item)

Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130

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:

TDP TM OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

16. REMARKS

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

1 1

0001 A MISC

CONSTRUCTION SERVICES TBD TBD

A003 Technical Report–Study/Services Environmental Impact Notice

DI-MISC-80508B Section 00 73 01, Subsection 23 NSWC PHD CODE 1022

LT

N/A D

ASREQ

N/A

SEE BLK 16

SEE BLK 16

BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only 18 JAN 2023. Other requests shall be referred to NSWC PHD.

BLK 12: First Submission for the Environmental Impact notice should be no longer than 3 days after contractor receives receipt.

BLK 13: Upon Government request.

BLK 14 &14a: Media Requirement. The report shall be delivered in Microsoft Office format (NMCI current deployed version) with E-mail notification to the following: ted.l.reed.civ@us.navy.mil (023- CS), siouzann.r.lende.civ@us.navy.mil (0231-KO), miguel.alamo4.civ@us.navy.mil (BD33-COR), forrest.w.linder.civ@us.navy.mil (CODE 1022-RG), chad.a.lousen.civ@us.navy.mil (1023)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 - 19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

CODE 023-CS 1

CODE 1022-RG 1

BD33-COR 1

CODE 0231-KO 1

CODE 1023 1

N/A

Forrest Linder

LINDER.FORREST.WILLIAM.1545953788 Digitally signed by LINDER.FORREST.WILLIAM.1545953788 Date: 2023.03.24 12:28:51 -07'00'

3/24/2023 Wendy Doman

DOMAN.WENDY.JO.1070425692 Digitally signed by DOMAN.WENDY.JO.1070425692 Date: 2023.03.27 07:25:30 -07'00'

(1 Data Item)

Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130

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:

TDP TM OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

16. REMARKS

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

1 1

0001 A MISC

CONSTRUCTION SERVICES TBD TBD

A004 Technical Report–Study/Services Traffic Control Plan

DI-MISC-80508B Section 00 73 01 Subsection 25 NSWC PHD CODE 1022

LT

N/A D

ASREQ

N/A

SEE BLK 16

SEE BLK 16

BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only 18 JAN 2023. Other requests shall be referred to NSWC PHD.

BLK 12 and 13: When requested by the Government.

BLK 14 &14a: Media Requirement. The report shall be delivered in Microsoft Office format (NMCI current deployed version) with E-mail notification to the following: ted.l.reed.civ@us.navy.mil (023- CS), siouzann.r.lende.civ@us.navy.mil (0231-KO), miguel.alamo4.civ@us.navy.mil (BD33-COR), forrest.w.linder.civ@us.navy.mil (CODE 1022-RG), carter.p.divine.civ@us.navy.mil (1024-SME)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 - 19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

CODE 023-CS 1

CODE 1022-RG 1

BD33-COR 1

CODE 0231-KO 1

CODE 1024-SME 1

N/A

Forrest Linder

LINDER.FORREST.WILLIAM.1545953788 Digitally signed by LINDER.FORREST.WILLIAM.1545953788 Date: 2023.03.24 12:29:27 -07'00'

3/24/2023 Wendy Doman

DOMAN.WENDY.JO.1070425692 Digitally signed by DOMAN.WENDY.JO.1070425692 Date: 2023.03.27 10:32:26 -07'00'

(1 Data Item)

Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130

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:

TDP TM OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

16. REMARKS

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

1 1

0001 A MISC

CONSTRUCTION SERVICES TBD TBD

A005 Technical Report–Study/Services Material Submitals

DI-MISC-80508B Section 00 73 01, Subsection 29 NSWC PHD CODE 1022

LT

A D

ASREQ

N/A

SEE BLK 16

SEE BLK 16

BLK 8: The Government will provide response within 5 business days. The Contractor has 3 business days to makes corrections.

BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only 18 JAN 2023. Other requests shall be referred to NSWC PHD.

BLK 12: First Submission for the Material Submittal should be prior to procurement of materials.

BLK 13: Prior to procurement of materials.

BLK 14 &14a: Media Requirement. The report shall be delivered in Microsoft Office format (NMCI current deployed version) with E-mail notification to the following: ted.l.reed.civ@us.navy.mil (023- CS), siouzann.r.lende.civ@us.navy.mil (0231-KO), miguel.alamo4.civ@us.navy.mil (BD33-COR), forrest.w.linder.civ@us.navy.mil (CODE 1022-RG)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 - 19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

CODE 023-CS 1 1

CODE 1022-RG 1 1

BD33-COR 1 1

CODE 0231-KO 1 1

4 4

N/A

Forrest Linder

LINDER.FORREST.WILLIAM.1545953788 Digitally signed by LINDER.FORREST.WILLIAM.1545953788 Date: 2023.03.24 12:30:10 -07'00'

3/24/2023 Wendy Doman

DOMAN.WENDY.JO.1070425692 Digitally signed by DOMAN.WENDY.JO.1070425692 Date: 2023.03.27 08:02:34 -07'00'

(1 Data Item)

Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130

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:

TDP TM OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

16. REMARKS

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

1 1

0001 A MGMT

CONSTRUCTION SERVICES TBD TBD

A007 Status Report Daily Report

DI-MGMT-80368A Section 00 73 02, Subsection 3 NSWC PHD CODE 1022

LT

N/A D

DAILY

N/A

SEE BLK 16

DAILY

BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only 18 JAN 2023. Other requests shall be referred to NSWC PHD.

BLK 12: First Submission for Daily Report should be the day after construction start date

BLK 14 &14a: Media Requirement. The report shall be delivered in Microsoft Office format (NMCI current deployed version) with E-mail notification to the following: ted.l.reed.civ@us.navy.mil (023- CS), miguel.alamo4.civ@us.navy.mil (BD33-COR), forrest.w.linder.civ@us.navy.mil (1022- RG)siouzann.r.lende.civ@us.navy.mil (0231-KO)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 - 19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

CODE 023-CS 1

CODE 1022-RG 1

BD33-COR 1

CODE 0231-KO 1

N/A

Forrest Linder, Code 1022

LINDER.FORREST.WILLIAM.1545953788 Digitally signed by LINDER.FORREST.WILLIAM.1545953788 Date: 2023.03.24 12:36:26 -07'00'

3/24/2023 Wendy Doman

DOMAN.WENDY.JO.1070425692 Digitally signed by DOMAN.WENDY.JO.1070425692 Date: 2023.03.27 11:02:50 -07'00'

(1 Data Item)

Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130

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:

TDP TM OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

16. REMARKS

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

1 1

0001 A MGMT

CONSTRUCTION SERVICES TBD TBD

A008 Contracting Officer's Management Report TESTING PLAN AND LOG

DI-MGMT-81864A Section 00 73 02, Subsection 4 NSWC PHD CODE 1022

LT

N/A D

MONTHLY

N/A

SEE BLK 16

SEE BLK16

BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only 18 JAN 2023. Other requests shall be referred to NSWC PHD.

BLK 12: First Submission for MONTHLY TESTING PLAN AND LOG REPORT should be 30 calendar days after construction start date.

BLK 13: Submit subsequent monthly reports one month following the date of the previous report

BLK 14 &14a: Media Requirement. The report shall be delivered in Microsoft Office format (NMCI current deployed version) with E-mail notification to the following: ted.l.reed.civ@us.navy.mil (023- CS), siouzann.r.lende.civ@us.navy.mil (0231-KO), miguel.alamo4.civ@us.navy.mil (BD33-COR), forrest.w.linder.civ@us.navy.mil (CODE 1022-RG)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 - 19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

CODE 023-CS 1

CODE 1022-RG 1

BD33-COR 1

CODE 0231-KO 1

N/A

Forrest Linder

LINDER.FORREST.WILLIAM.1545953788 Digitally signed by LINDER.FORREST.WILLIAM.1545953788 Date: 2023.03.24 12:31:52 -07'00'

3/24/2023 Wendy Doman

DOMAN.WENDY.JO.1070425692 Digitally signed by DOMAN.WENDY.JO.1070425692 Date: 2023.03.27 07:45:36 -07'00'

(1 Data Item)

Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130

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:

TDP TM OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

16. REMARKS

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

1 1

0001 A MGMT

CONSTRUCTION SERVICES TBD TBD

A009 Contracting Officer's Management Report Summary Report of Field Tests

DI-MGMT-81864A Section 00 73 02, Subsection 4 NSWC PHD CODE 1022

LT

N/A D

MNTLY

N/A

SEE BLK 16

SEE BLK16

BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to the Department of Defense and U.S. DoD contractors only 18 JAN 2023. Other requests shall be referred to NSWC PHD.

BLK 12: First Submission for Monthly Summary Report of Field Tests should be 30 calendar days after construction start date.

BLK 13: Submit subsequent monthly reports one month following the date of the previous report.

BLK 14 &14a: Media Requirement. The report shall be delivered in Microsoft Office format (NMCI current deployed version) with E-mail notification to the following: ted.l.reed.civ@us.navy.mil (023- CS), siouzann.r.lende.civ@us.navy.mil (0231-KO), miguel.alamo4.civ@us.navy.mil (BD33-COR), forrest.w.linder.civ@us.navy.mil (CODE 1022-RG)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 - 19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

BLK16: Monthly Summary Report of Field Tests are to be attached to the QC Report

CODE 023-CS 1

CODE 1022-RG 1

BD33-COR 1

CODE 0231-KO 1

N/A

Forrest Linder

LINDER.FORREST.WILLIAM.1545953788 Digitally signed by LINDER.FORREST.WILLIAM.1545953788 Date: 2023.03.24 12:36:51 -07'00'

3/24/2023 Wendy Doman

DOMAN.WENDY.JO.1070425692 Digitally signed by DOMAN.WENDY.JO.1070425692 Date: 2023.03.27 10:41:36 -07'00'

3/24/2023

(1 Data Item)

Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130

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:

TDP TM OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

16. REMARKS

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15.TOTAL

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

1 1

0001 A ADMN

CONSTRUCTION SERVICES TBD TBD

A010 Meeting Minutes QUALITY CONTROL MEETING MINUTES

DI-ADMN-81250C Section 00 73 02, Subsection 4 NSWC PHD CODE 1022

LT

N/A D

ASREQ

N/A

SEE BLK 16

SEE BLK 16

BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to the Department of Defense and U.S. DoD contractors only 18 JAN 2023. Other requests shall be referred to NSWC PHD.

BLK 12 and 13: First Submission for Quality Control Meeting Minutes should be within two days of first Quality Control Meeting. Subsequent reports due two (2) business days after each meeting.

BLK 14 &14a: Media Requirement. The report shall be delivered in Microsoft Office format (NMCI current deployed version) with E-mail notification to the following: ted.l.reed.civ@us.navy.mil (023- CS), siouzann.r.lende.civ@us.navy.mil (0231-KO), miguel.alamo4.civ@us.navy.mil (BD33-COR), forrest.w.linder.civ@us.navy.mil (CODE 1022-RG)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties.

Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 - 19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

CODE 023-CS 1

CODE 1022-RG 1

BD33-COR 1

CODE 0231-KO 1

N/A

Forrest Linder

LINDER.FORREST.WILLIAM.1545953788 Digitally signed by LINDER.FORREST.WILLIAM.1545953788 Date: 2023.03.24 12:37:26 -07'00'

3/24/2023 Wendy Doman

DOMAN.WENDY.JO.1070425692 Digitally signed by DOMAN.WENDY.JO.1070425692 Date: 2023.03.27 08:14:30 -07'00'