CONTRACT DATA REQUIREMENTS LISTS (9 CDRLs).pdf

CONTRACT DATA REQUIREMENTS UST Form Approved

{1 Data Item) 0MB No. 0704-0188

Public reporting burden for this collection of Information is estimated to average 110 hours per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding thus bunlen 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 lo the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either or these addresses. Send comoleted form to the Government lssulna Conlractina Officer for the Contract/PR No. listed In Block E.

A. CONTRACT LINE ITEM NO. B.EXHIBIT C. CATEGORY:

TOP □ TM □ OTHER D

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

LOW PRESSURE AIR COMPRESSOR (LPAC)

1.DATAITEMNO. 2, TITLE OF DATA ITEM J.SUBTITLE

Electrical Test Report Electrical Functioning Test Report

4. AUTHORITY (D•t• AcqulsltJon Doc:umem Na.) 5. CONTRACT REFERENCE 6, REQUIRING OFFICE

DI-NDTl-80809B SOW Paragraph 5.2.3.1 PURCHASING ACTIVITY

7.00250 REQ 9. DIST STl,TEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14, DISTRl8l/TION

DD

REQUIRED

ONE/R SEE BLK 16

8,4PPCODE D 11.ASOFDATE 13 DATE OF SUBSEQUENT a. "DDRESSEE

SUBMISSION

NIA N/A N/A

16, REMARKS SEE BLK 16

Block 4 - Tailored to allow vendor to provide only 10.2.1, 10.2.2, 10.2.3.2, 10.2.3.3 10.2.5, 10.2.6.4.1, 10.2.6.4.2 and 10.2.6.5

Block 9 - Distribution Statement D. Distribution authorized to DoD and DoD contractors only. Administration and operations only, effective 6/6/2023. Other U.S. requests shall be referred to COMNAVSEASYSCOM

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) a-Business Suite.

Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Block 14 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) e-Business Suite.

Upon submission in WAWF send email notifications to:

Joshua.n.timmer.civ@us.navy.mil, Brittany.e.mcquaig.civ@us.navy.mil.

Document No.: 3111-1 050 1� •Olal

G. PREPARED BY H.DATE I. APPROVED BY

TIMMER.JOSHUA.Nie �iR���-Noco 121108,.60, HAWKINS.RICHAR =�.:..out.,., .. .,.

0.1290614607 0..0 2023.0l.120Ul:13.07'00'

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CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) 0MB No. 070"90188

Public reporting burden for this collection of Information is estimated to average 110 hours per response, Including the Ume for reviewing Instructions, sean:hlng existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of lnfonnaUon. Send comments regarding thus burden estimate or any other aspect of this collection o f information, Including suggestions for reducing this burden, lo Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and lo 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 comoleted form to the Government Issuing Contracting Officer for the Contracl/PR No. listed In Block E.

A CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TOP □ TM □ OTHER □

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

LOW PRESSURE AIR COMPRESSOR (LPAC)

1.DATArrEM NO. 2. TrrLE OF DATA rrEM J. SUBTITLE

ENGINEERING DATA Engineering Data for Provisioning (EDFP)

4. AUTHORITY /l»I• At:quls/llon Dacvmtnt Ho.} 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-SESS-8187 4 SOW Paragraph 5.5 PURCHASING ACTIVITY 7.D0250 REQ 9. DIST STATEMENT 10. FREQUENCY 12-DATE OF FIRST SUBMISSION 14. OISTRIBUTION

REQUIRED

SEE BLK 16DD ONE/R b.COPIES

8 APPCODE D 11. AS OF DATE 13 DATE OF SUBSEQUENT a. ADDRESSEE DRAFT FINAi.

SUBMISSION

N/A N/A N/A Rog R.., 16.REMARKS SEE BLK 16 0 1 0

Block 4: Tailored to allow the vendor to only provide: 3.1, 3.2, 3.4, 3.5, and 3.7 and 3.8. Provide actual values IAW procurement specification. Ensure certs provided are traceable to material via unique markings

Block 9 - Distribution Statement D. Distribution authorized to DoD and DoD contractors only. Administration and operations only, effective 6/6/2023. Other U.S. requests shall be referred to COMNAVSEASYSCOM Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) e-Business Suite.

Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Block 14 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) e-Business Suite.

Upon submission in WAWF send email notifications to:

Joshua.n.timmer.civ@us.navy.mil, Brittany.e.mcquaig.civ@us.navy.mil.

Document No.: 3111-1 050 l� T�

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

TIMMER.JOSHUA.Nie =��:,_,�Nico 12901,.601 HAWKINS.RICHAR =��.:.om,,.,__, 6/7/23 0.1290614607 o ... , 202306.1201'26:54-07'00'

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B001

(1 Data Item) OMS No. 0704-0188

Public reporting burden for this collection of information is estimated to average 11 O hours per response, lndudlng the lime for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of lnrormalion. Send comments regarding thus burden estimate or any other aspect or this colfecUon o f lnfonnallon, lndudlng suggesllons for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for lnfonnaUon Operallons 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 rorm to either of these addresses. Send completed fonn to the Government lssuln!l Contractln!l Officer for the Contract/PR No. listed In Block E.

A. CONTRACT LINE ITEM NO. B.EXHIBIT C. CATEGORY:

TOP □ TM □ OTHER D

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

LOW PRESSURE AIR COMPRESSOR (LPAC)

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

Hydrostatic Test Report Hydrostatic Pressure Test Report

... AUTHORITY (Dall Acqu/sl!Jon Document No.J 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTl-80809B SOW Paragraph 5.2.1.1 PURCHASING ACTIVITY

7.00250 REQ 9. DIST STATEMENT 10, FREQUENCY 12 .. DATE OF FIRSl SUBMISSION

DD

REQUIRED

ONE/R SEE BLK 16

8.APPCOOE D 11.ASOFDATE 13. DATE OF SUBSEQUENT

SUBMISSION

N/A N/A N/A

16,REMARKS

Block 4 - Tailored to allow vendor to provide only 10.2.1, 10.2.2, 10.2.3.2, 10.2.3.3 10.2.5, 10.2.6.4.1, 10.2.6.4.2 and 10.2.6.5

Block 9 - Distribution Statement D. Distribution authorized to DoD and DoD contractors only. Administration and operations only, effective 6/6/2023. Other U.S. requests shall be referred to COMNAVSEASYSCOM

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) e-Business Suite.

Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Block 14 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) a-Business Suite.

Upon submission in WAWF send email notifications to:

Joshua.n.timmer.civ@us.navy.mil, Brittany.e.mcquaig.civ@us.navy.mil

Document No.: 3111-1 050

G. PREPARED BY H.DATE I. APPROVED BY

14 OISTRl811TION

• ADDRESSEE

SEE BLK 16

1$ Tlllai

TIMMER.JOSHUA.Nie ��R·_::,� Noco 1290a,.,,a, HAWKINS.RICHAR ==.::.OllE.1111-.0

Q.1290614607 Doto 2Cl23.0812Ge:27:51-

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(1 Data Item) 0MB No. 0704-0188

Public reporting burden for this collection of Information is estimated lo average 11 O hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding thus burden estimate or any other aspect or lhls collection o f lnformallon, Including suggestions for reducing this burden, lo Department or Defense, Washington Headquarters Services, Oireclorale for Information Operations and Reports, 1215 Jefferson Davis Highway, Suile 1204, Arlington, VA 22202-4302, and lo the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form lo either of these addresses. Send comoleted form to the Government lssuln11 Contractin11 Officer for the ContracVPR No. listed In Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TOP □ TM □ OTHER D

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

LOW PRESSURE AIR COMPRESSOR (LPAC)

1, DATA rrEM NO. 2. TrrLE OF DATArrEM l.SUBTITLE

Test Report Operational Test Report

�-AUTHORITY/Oat• Acqulsltloll Docu,.,.,,, No.) 5. CONTRACT REFERENCE 6, REQUIRING OFFICE

0I-N DTl-808098 SOW Paragraph 5.2.2.1 PURCHASING ACTIVITY

7. D0250REQ 9, DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

DD

REQUIRED

ONE/R SEE BLK 16

8.Al'PCODE D 11. AS OF DATE 13. DATE OF SU8SEOUENT

N/A

SUBMISSION

N/A N/A

16. REUARKS

Block 4 - Tailored to allow vendor to provide only 10.2.1, 10.2.2, 10.2.3.2, 10.2.3.3 10.2.5, 10.2.6.4.1, 10.2.6.4.2 and 10.2.6.5

Block 9 - Distribution Statement D. Distribution authorized to DoD and DoD contractors only. Administration and operations only, effective 6/6/2023. Other U.S. requests shall be referred to COMNAVSEASYSCOM

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) e-Business Suite.

Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Block 14 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) a-Business Suite.

Upon submission in WAWF send email notifications to:

Joshua.n.timmer.civ@us.navy.mil, Brittany.e.mcquaig.civ@us.navy.mil.

Document No.: 3111-1 050

G. PREPARED BY H.DATE I. APPROVED BY

14. DISTRIBUTION

a. ADDRESSEE

SEEBLK 16

15. T(llal

TIMMER.JOSHUA.NIC c,g,1a1y ,;gn..i "Y Q, 1290614607

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0002AD D

D001

Public reporting burden for this collection of Information is estimated to average 11 O hours per response, Including the lime for reviewing instructions, searching exlstlng data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding thus burden estimate or any other aspect of this collection o f Information, Including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN youdonn 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.EXHJBIT C. CATEGORY:

TOP □

™ □ OTHER D

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

LOW PRESSURE AIR COMPRESSOR (LPAC)

1,DATAITEMNO, 2, TITLE OF DATA ITEM 3.SUBTITLE

TEST PLAN REPORT Quality Conformance Production Test (Planning)

4, AUTHORITY (Dara Acquls/1/on Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTl-80603A SOW Paragraph 5.3 PURCHASING ACTIVITY

7.OD250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

DD

REQUIRED

ONE/R SEE BLK 16

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

N/A

SUBMISSION

A

SEE BLK 16

18,REMARKS

Block 4 - Tailored to allow the vendor to only provide requirements from paragraphs 2 and 3, Provide actual values IAW procurement specification, Ensure certs provided are traceable to material via unique markings.

Block 9 - Distribution Statement D. Distribution authorized to DoD and DoD contractors only. Administration and operations only, effective 6/8/2023. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12 - Draft Certification/Data Report documentation shall be sent to Joshua Timmer @ Joshua.n.timmer.civ@us.navy.mil. Allow 14 days from submission of draft for government to review/ approval.

Block 13- Subsequent drafts will be required based on comments from government review. Final report is due within 14 days after receipt of draft approval.

Block 14 - Send Draft and Final Certification/Data Report documentation to Joshua.n.timmer.civ@us.navy.mil

Document No.: 3111-1050

G. PREPARED BY H.DATE I. APPROVED BY

14 DISTRIBUTION

a. ADDRESSEE

SEE BLK 16

I!> t,l)'.aj

TIMMER.JOSHUA.Nie �:���:�_ .. ,co 12908,.601 HAWKINS,RICHAR =��0UE.1111 Q.1290614607 Delo: 202301.12 01211:27-ll7W'

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Page b.COPIES

DRAFT JINA�

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0 1 0

J.DATE

6/7/23 of Pages

0002AE E

E001

(1 Data Item) 0MB No, 0704-0188

Public reporting burden for this collection of lnformaUon Is estimated to average 110 hours per response, Including the lime for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding thus burden estimate or any other aspect of this collection o f information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Artinglon, VA 22202-4302, and lo the Office of Management and Budget. Paperwor1< Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses Send comoleled form to the Government lssuina Contractina Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TOP D TM □ OTHER D

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

LOW PRESSURE AIR COMPRESSOR (LPAC)

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

Test Report Quality Conformance Production Test

4, AUTHORITY (Data Acqu/slllan Document Na.) 5. CONTRACT REFERENCE &. REQUIRING OFFICE

D1-N DTl-80809B SOW Paragraph 5.4 PURCHASING ACTIVITY

7. DD 250 REQ 9 01ST STATEMENT 10. FREQUENCY 12, DATE OF FIRST SUBMISSION

DD

REQUIRED

ONE/R SEE BLK 16

8 APPCODE D 11. AS OF DATE 13. DATE OF suaseauENT

SUBMISSION

N/A N/A N/A

16 REMARKS

Block 4 - Tailored to allow vendor to provide only 10.2.1, 10.2.2, 10.2.3.2, 10.2.3.3 10.2.5, 10.2.6.4.1, 10.2.6.4.2 and 10.2.6.5

Block 9 - Distribution Statement D. Distribution authorized to Do□ and DoD contractors only. Administration and operations only, effective 6/6/2023. Other U.S. requests shall be referred to COMNAVSEASYSCOM

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) e-Business Suite.

Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Block 14 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) e-Business Suite.

Upon submission in WAWF send email notifications to:

Joshua.n.timmer.civ@us.navy.mil, Brittany .e.mcquaig.civ@us.navy.mil.

Document No.: 3111-1 050

G. PREPARED BY H.DATE I. APPROVED BY

14 DISTRIBUTION

a.ADDRESSEE

SEE BLK 16

IS. T�

TIMMER.JOSHUA.Nie =�".:;':',�N,co ,ma .. ao, HAWKINS.RICHAR ::r.:,:;-,.=.:•om.11a, Q, 1290614607 Dalo: 2023.06.12 01:Sl:57-01'00'

DD FORM 1423•1, JUN 90 (EG)

D.LEE.1161646500 1,.,. :.z, .... ,.., .... _

Page

b. COPIES

PRAFT FrmL

Reg R...,.

0 1 0

J.DATE

6/7/23 of Pages

1'.ftUEl

0002AF F

F001

Public reporting burden for this collection of Information Is estimated to average 110 hours per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding thus burden estimate or any other aspect of this collection o f lnformatron, 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 lo eilher of these addresses. Send completed form to the Government Issuing Contracting Officer for the ContracVPR No. lisled In Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TOP □ TM □ OTHER D

D. SYSTEMIITEM E. CONTRACTIPR NO. F. CONTRACTOR

LOW PRESSURE AIR COMPRESSOR (LPAC)

1,DATAITEMNO. 2. TITLE OF DATA ITEM 3. SUBTITLE

Technical Manual Updates Red-Line Copy of Technical Manual

4. AUTHORITY (Dal• Acqulslllon Document No.) 5. CONTRACT REFERENCE

DI-MISC-82386 * SOW Paragraph 5.6

7.OO250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

DD

REQUIRED

ONE/R SEE BLOCK 16

8 APPCOOE D 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

N/A N/A N/A

16.REMARKS

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only. Administration and operations only, effective 6/8/2023. Other U.S. requests shall be referred to COMNAVSEASYSCOM

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) e-Business Suite.

Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Block 14 - Certification/Data Report documentation shall be attached in the Wide Area Workflow (WAWF) e-Business Suite.

Upon submission in WAWF send email notifications to:

Joshua.n.timmer.civ@us.navy.mil, Brittany.e.mcquaig.civ@us.navy.mil *DI-MISC-82386 Paragraph 4, Technical content shall be per Navy Tech Manual S6220-EE-MMA-A10 or S6220-EU-MMA-01 O and shall meet the requirements of the SOW Paragraph 5.6

Document No.: 3111-1 050

G. PREPARED BY H.DATE I. APPROVED BY

6, REQUIRING OFFICE

PURCHASING ACTIVITY

14 DISTRIBUTION

b, COPIES a, ADDRESSEE DRAFT P.NAL

Rog R"'"'

N4523A 0 1 0

SEE BLOCK 16

I&, Tot.ii

J.DATE

TIMMER.JOSHUA.NIC �::��9;=� Nico 12906.,807 HAWKINS.RICHAR :::.:::::�.:..DU:E.1111-,0

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Page of Pages

11.H .. u,no TCll'A&.PlltEt:

0002AG G

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CONTRACT DATA REQUIREMENTS LIST Form Approved (2 Data Items} 0MB No. 0704-0188

The public reporting burden fa, thi1 caUection of lnformatkln ril o,1irnated to average 220 ho1,,1r1 p-, retpon11 1 nc:Fuding the time for reviewing in1truc1i-on1, searching axiating data 1ource1. gathering ■nd maintaining the data needed, and completing •nd reviewing the collection of Information, Send comments regarding thit burden estimate 01 any other 11pect of thi1 conection of in formation, sncludin; 1ugge1t1on1 for reducing the burden, to the Dep■runent of Defense, Executive Servicet Directora11 10704-01881. Re1polld1nt11houtd be aware thal notwithstanding any other provision of law, no paraon shall be subject to any penal1y for failing to comply with a i::all•c,ion of er\formation If It does not display • c,mentlv valid 0MB control number. Pleue do Ml retum your (Offfl to the above o,ganlzatlon. Send completed form to 1he Govemmant l11ulng Contracting Officer for th■ Contrect/PR No. Roted In Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM_ OTHER

F. CONTRACTOR I D. SYSTEM/ITEM

I

E. CONTRACT/PR NO.

LOW PRESSURE AIR COMPRESSOR (LPAC) 1,

1. DATA ITEM NO. 2, TTT\E OF DATA ITEM 3. SUBTITLE

FIRST ARTICLE TEST REPORT Airborne and Strudure Bome Noise Qualification TEST flEPORT

4. AUTHORITY /Dall Acq.,;o,);,,,, Document /Yo./ 16. CONTRACT REFERENCE 6. REQUIRING OFFICE ., 'II.

DI-NDTl-808098 SOW Paragraph 5.1-2.1 PURCHASING AQlil\JljY '\

7. DD 260 REQ 9. 01ST STATEMl!NT 10. fRfOUENCY 12. DATE OF FIRST SUBMISSION 14, DISTRIBUl\ON. A,::..-) i

DD REQUIRED ONE/R SEE BLK 16 ";b?c;� I

8, APP CODE

D

11. AS OF DATE 13. DATE OF SUBSEQUENT a, ADDRESSEE -

' Fi✓ N/A N/A SUBMISSION Draft NIA \ R'k"' Rep,o

16.REMARKS �t:t: l:SLI\ lb \ ...., .D - .1, , 0

Block 4 - Tailored to allow vendor to provide only 10.2.1, 10.2.2, 10.2.3.2, 10.2.3.3 V , 10.2.5, 10.2.6.4.1, 10.2.6.4.2 and 10.2.6.5 ��\ \. �v J . ' Block 9 - Distribution Statement D. Distribution authorized lo DoD and DoD contractors only. I. -�

Administration and operations only, effective 6/6/2023. Other U.S. requests shall be referred lo COMNAVSEASYSCOM r ,- V Block 12 - Contractor must submit within 90 days of contract award, � 1\ -

Block 14 - Certification/Data Report documentation shall be attached In the Wide Area �-,.� Workflow �AWF) e•Buslness Suite. Upon submission In WAWF send �e�il-notilicatlons to:

Joshua.n.tlmmer,clv@us,navy.mll @Jlttany,e.mequaig.��uf.nayy,IQ_:lf Allow 30 Days from date of entry In WAWF for certification acceptance,prlor to perfonnance of any test.

A "-..Y 16. TOTAL u ·1 u

1. DATA ITEM NO. 2. TITLE OF DATA ITEM ,, ' " 3,SUBTITI.E

FIRST ARTICLEt

TEST R6PORT Aibome and Sllrucalra 8� NolM Ouallflcatlon fESt REPORT PRIOR ACCETANC&

4. AUTHORITY /Dara Acquisition Do�umettl No. I , 71"' CONTRADT REFERENCE DI-NDTl-808098 _ SQW Paragraph 5.1.2.2

7. 00 250 REQ 9 DIST STATEMENT il10�FR£QUENCY "I

✓� 12. DATE OF FIRST SUBMISSION

DD REQUIRED ,I ONE/.ij , SEE BLK 16

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

D � N/A ' NJ� SUBMISSION

NIA

16.REMARKS .

Block 4 - Tailored 10•a110w endor, o provide only 10.2.1, 10.2.3.2 and 10,2.7 .2 .

Block 9 - Distribution ilatement OiDlstribution authorized to DoD and DoD contractors only.

Admlnistrijtlonand operations 911iy, effective 616/2023. Other U.S. requests shall be referred to CO AVSEASYSCOM Block 12 - Sl:lbmit.prlil? or prior acceptance 7 days after Contract Award .

� Bloc�.14 - Certification/Data Report documentation shall be attached In the Wide Area

WOJf(flow �AWF) e-Buslness Suite Upon submission In WAWF send email notifications to:

Jomua,n,t\rmne, civ@us. n:avt,mM Brittany e, mcgua19,Qi11@us. nayyJ!!Y. Allow 45 Days)om date of entry in WAWF for certification acceptance prior to material shipment.

Document number: 3111-1051

G. PREPARED BY H. DATE I. APPROVED BY

5. REQUIRING OFFICE

PURCHASING ACTIVITY

14. OISTRIBUTION

b, COPIES

1. ADDRESSEE Final Drat1

Rog Aepro

SEEBLK 16 0 1 0

16, TOTAL u I u

J. DATE

/S/ Joshua Timmer (C/280.41) 6/6/23 ISi Richard Hawkins (cl520.3) 6/6/23 DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAY BE USED. Page __ of __ Pages

Adobe Professional 8.0

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I

18, EmMATBl I

TnTAL PRICE

17. PRICE GROUP

?B. ESTIMATBl

TOTAL PRICE

0004AA H

H001

H002

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010. 12•M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP • Technical Data Package; TM • Technical Manual; Other • other category of data. such as "Provisioning," "Configuration Management,• etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in alter contract awardl.

Item F. Self-explanatory (to be filled in alter contract awardl.

Item G. Signature of preparer of CORL.

Item H. Date CORL was prepared.

Item I. Signature of CORL approval authority.

Item J. Date CORL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DIDI number, military/ specification number, or military standard number listed in OoQ...

5010.12-L (AMSDLI, or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generat� requirement for the data item (e.g., Statement al Work paragraph number!.

Item 6. Enter technical office responsible 'for ensuring adequacy of the data item.

Item 7. Specify requirement for inspee1ion/acbeptance of-_;the data item by the Government. / } Item 8. Specify requirement for ap11roval of a draft before preparation al the final data itern. ..., Item 9. For technical data! specify reqll\!'.!!men for contractor to mark the appropriate dlstnbution statelJlent on the data (ref.

DoDD 5230.241.

Item 10. Specif number of times data items are to be delivered. ) Item 11. Specify as\if date of data item, when applicable.

Item 12. Speci'X'(;..hen firstisubmittal is required.

Item 3�'Specify w y h �bsequent submittals are required, wtien applicable.

ltam ... 14, Enter �ressees and number of draft/final copies to tie, delivered to each addressee. Explain reproducible copies in lt�m 16.

�lam 15. enter total number of draft/final copies to be delivered.

Item.., 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies In Item 14.; Desired medium for delivery of the data item.

DD FORM 1423-2 (BACK), AUG 96

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the fo�owing groups of effort in developing estimated prices for each daw<1tem listed on the DD Form 1423.

a. Group I. Definition • Data which Is not otherwise esseMial�o the contractor's performance of the primary contracted elfon_ (production, development, testing. and administration! but whlch) required by DD Form 1423. '

Estimated Price· Costs to be inciGed upder-Group�I are those applicable to preparing and assa,bling� the datll' item in conformance with Government requiremen s, and the administration and other expenses related to .,reproducing and delivering such data ltems to·the Government.

b. Group II. Delinwtion Data v,,hich is essential to the performance ol t,!J!:.llrimary contracted effort but the contractor is required to perform 'ecfditionat �gi-k to conform to Government requirements.,,with regarl:t to depth'of content, format, frequency of submittal, preparatlo,,conttg.!:_,.or quality of the data item.

.,, Esti!!JBlf!d �i°'-'- Costs to be Included under Group II are those "'Incurred over;11nif above the cost of the essential data item

/�thout �Of;?lormlng to Government requirements, and the adrriinistratlv,e ay,ii other expenses related to reproducing and delivering sucp•data item to the Government, e,,GJOUP Ill. Definition• Data which the contractor must develop for his Internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, "frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group Ill are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition • Data wh:ch is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government Is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items}

Form Approved

0MB No. 0704•0188

The public ,,porting burden foc thi1 cotrectKJn of information i1 e1timated to average 220 hour, per 1eepon11, inctvding the time for ,eviewing in1truction1. searching existing data 1ou,c1111, gathering and maintaining the data needed, and eomple1jng and reviewing the coHtetion of inform,tlon, Send commerita 1eg•rd1r,g this burden estimate o, anyother 11pect of 1hi1 collection of informat•on, Including 1ugge11ion1 for reducing thoe butden, to the Department of Oehm11. E11ecutive Service■ 0ir1ctora11 t0704-0188). R11pondent1 lhoukt be aware that notwithatanding any other provision of law, no petson shall be subject to any penalty for failing to comply with• collection ol inrormatlon If It does not di1plav a currently valid 0MB control number. PleaH da not retum your fonn to 1h11 abave a,ganb:atlon� Send completitd form 10 11\e Oavomment l11ulng Contracting Olflcor far the Can1rat1/PR No. hied In Block E, A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TI>P TM_ OTHER

F.CONTRACTOR D. SYSTEM/ITEM

E. CONTRACT/PR NO.

�L�O�W�P�R�E�S�S�U_R�E�A�IR�C�O�M�P�R�E�S�S�O�R _(L_P_A_C_)._ _________ ......,...,...,,...,....,... ______________ .....__� # •1. DATA ITEM NO. 2- TinE OF DATA ITEM 3. SUBTfTLE 17,PRICE GROUP

FIRST ARTICLE TEST REPORT

,, SHOCK,VIBRATION 4 El.ECTROMACNET!t INTlaRFEREHCE �T�PORT r 4, AUTHORITY rD•to AcqiJl>;tion �mMI No.I DI-NDTl-80809B 1

6. CONTRACT REFERENCE

SOW Paragraph 5.1.1.1

7, DD 260 REQ 9. DIST STATEMENT 10, l'!IEQUENCY 12. DATE OF FIRST SUBMISSION

DD REQUIRED ONE/R SEE BLK 16

8. APP CODE

D N/A

16. REMARKS

11. AS OF DATE

NIA

13, DATE OF SUBSEQUENT

SUBMISSION

N/A

Block 4 • Tailored to allow vendor to provide only 10.2.1, 10.2.2, 10.2.3.2, 10.2.3.3 10.2.5, 10.2.6.4.1, 10.2.6.4.2 and 10.2.6.5

II. REQUIRING OFFICE "'

PURCHASING AG,TI\/IJ,Y

1-- 1_4_. _____ 0_1s_TR_111-i"-TION""c. }"':, \- �

, b?cOPIES '1 I

-. ADDRESSEE

,,Fi.,/' Draft R'og Rep,o

SEE BLK 16 \ .... 9...., .... _ ,,,, 0

V , � lJ )..

Block 9 • Distribution Statement D. Distribution authorized lo DoD and DoD contractors onlyil-."'-,l�-.:=!�'�...,C.&...=:::�::::!!�+--l--i---1 Administration and operations only, effective 6/6/2023. Other U.S. requests shall be refemfd , _ to COMNAVSEASYSCOM 1-,;.,----' ...... ..,,-=------+--+---+---1 Block 12 • Contractor must submit within 90 days of contract award.

Block 14 • Certification/Data Report documentation shall be attached In the Wide Area Workflow (YVAWF) e-Buslness Suite. Upon submission In WAWF send ,eii'ail-nolifications to:

Joshua.nJlmmeLcJM@us.naw.mil. Bnttanv.e,mcquaig.ctt@us,n::iw,,m1 Allow 30 Days from date of entry In WAWF for certification acceptance prior to performance of any test.

""y

16, TOTAL u u

1. DATA ITEM NO. 2. TinE OF DATA ITEM

FIRST ARTICL� T�ST REPORT

, l.SUBTinE

IHOC«.\'$1tA'hON .t El£¢� rNtlllrtJtEHCf ft Sf AfPOIIT .,._K>SI AC CE TA.NCI!

4. AUTHORITY (Data Acquisition Oocumdnt No. I D1-NDTl-808098 ri, I. CONTRACT REFERENCE _ r SQ\/'! Parag-raph 5.1.1.2

7. DD 260 REQ 9. DIST STATEMENT

.,J

�10�FIIEO�!!CY '

...,,.......,=D,....,D __ - REQUIRED

/ r I ONE(R J

8. N/ADE

O R

AS

oN:;r

, 16. REMARKS

.. 12. DATE OF FIRST SUBMISSION

SEE BLK 16

13, DATE OF SUBSEQUENT

SUBMISSION

NIA

Block 4-Tailored td'allow�endorJo provide only 10.2.1, 10.2.3.2 and 10.2.7.2.

Block 9 • Distribution Stat.ement g,. Distribution authorized to DoD and DoD contractors only.

Adminlstr�on ai:i<1 operations !)lily, effective 6/6/2023. Other U.S. requests shall be referred to C�AVSEASYSCOM J, Block 12 • S�ll proofof prior acceptance 7 days alter Contract Award.

I�

.,....:, Block 14 • Certification/Data Report documentation shall be attached In the Wide Area Worttnow r,NA�) e-Buslness Suite. Upon submission In WAWF send email notifications to:

Joshuan,Hmmer. civ@us,nayy.mil Brittany e,mcc11Jalg,ciY@us.nayy.mil. Allow 45 Days)°in date of entry in WAWF for certification acceptance prior to material shipment.

Document number: 3111-1051

G. PREPARED BY H. DATE I. APPROVED BY

6, REQUIRING OFFICE

PURCHASING ACTIVITY

14. DISTRIBUTION

b. COPIES •• ADDRESSEE F'01ol

SEEBLK 16

Draft 1---.....---t

Reg Repro

1-----+--+---+--11 t------11 -----1

-----1

-----1 t------1

----...... --+T-T-+n---l-r-T-11

15. TOTAL U I U

IJ. DATE

ISi Joshua Timmer (Cl280.41) 6/6/23 ISi Richard Hawkins (c/520.3) 6/6/23 DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAV SE USED. Page __ of __ Pages

Adobe Professional 8.0

1 B, ESTIMATED

TOTAL PRICE

17. PRICE GROUP

18. ESTIMATED

TOTAi. PRICE

0004AB J

J001

J002

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010. 12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TOP • Technical Data Package; TM • Technical Manual; Other - other category of data, such as "Provisioning, ""Configuration Management." etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CORL.

Item H. Date CORL was prepared.

Item I. Signature of CORL approval authority.

Item J. Date CORL was approved.

Item 1. See OoD FAR Supplement Subpart 4. 7l for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item !optional entry).

Item 4. Enter Data Item Description (DIDI number, military ✓ specification number, or military standard number listed in Doi), 5010.12-L (AMSDL), or one-time DID number, that defines d1fa content and format requirements.

Item 6. Enter reference to tasking in contract that generatM requirement for the data item !e.g., Statement of Work paragraph number). ( Item 6. Enter technical office responsible for ensuring\ adequacy of the data item.

,,/'-, Item 7. Specify requirement for inspection/acceptance <0Hie data item by the Government.

Item 8. Specify requirement f� approval of a draft be lore preparation of the final data item.

Item 9. For technical data, specify requ�emen for contractor to mark the appropriate dlstributi on state1J1ent on the data [ref.

DoDD 5230.241. I

Item 10. Specify number � times data items are to be delivered. / Item 11. Specify 7t date of data item, when applicable.

Item 12. �pecitt'V,lhe; fiJt> submittal is required.

Item 13

Specify hen�bsequent submittals are required, when appJicable. / Item l'4: Enter-addressees and number of draft/final copies to 6a delivered to each addressee. Explain reproducible copies in Item 16.

Item 16. eKter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

DD FORM 1423-2 (BACK), AUG 96

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the folloV'!ing groups of effort in developing estimated prices for each data<ttem listed on the DD Form 1423.

a. Group I. Definition • Data which is not otherwise essenti,il to � the contractor's performance of the primary ,contracted e·ffan., � [production, development. testing, and administration) but whLch ·,, required by DD Form 1423. '

Estimated Price - Costs to be inc/Uded u er-Group�L,ere those applicable to preparing and aaseFT1bling the 'data item in conformance with Government ·reqEiiremen't., and the administration and other expenses relatecl to ieproducing and delivering such data items to�ffie Government.

b. Group II. Definition Data 'lf,'llich is essential to the performance of the·t:rimary con acted effort but the contractor is required to periorm additional wo;k to conform to Government requirements,-witl\ regard to depttj of content, format, frequency of submittal,,preparatlol')/ coritto�.or quality of the data item.

J � Estimat�d �ric,r- Costs to be included under Group II are

�tpose l11cured over7anil above the cost of the essential data item /without conformtpg to Government requirements, and the aci'rnin istratlve �nd other expenses related to reproducing and delfvering sucp•data item to the Government.

c. G_Joup Ill. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantiat change to conform to

.,.Government requirements with regard to depth of content.. format, _.. �requency of submittal, preparation, control, and quality of the data item.

Estimated Price • Costs to be included under Group Ill are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price • Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portfon of the total price which is est/mated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result ol the requfrement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's r,ght to use the data shall be governed by the pertinent provisions of the contract.