Exhibit A_CDRLS.pdf

CONTRACT DATA REQUIREMENTS LIST (CDRL)

(1 Data Item)

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

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

TDP TM OTHER

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

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

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

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

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

Draft

Final Reg Repro

16. REMARKS

15. TOTAL ▬▬▬▬►

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

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page of Pages

0009 A

HAZARDOUS WASTE PICKUP TBD

A001 ACCIDENT / INCIDENT REPORT SPILL REPORT

DI-SAFT-81563 PWS PARA 5.4 N00253

LT

D

ASREQ ASREQ

N/A N/A ASREQ

PCO

ON-SITE POC 0

010COR

1 0

12/14/2023

14DEC2023

1 1

BARNES.ELIZABET

H.RAE.1594391230

Digitally signed by

BARNES.ELIZABETH.RAE.159439

Date: 2023.12.14 13:59:05 -08'00'

STIGLICH.PAUL.AN

THONY.1150153065

Digitally signed by

STIGLICH.PAUL.ANTHONY.11501

53065 Date: 2023.12.14 14:39:53 -08'00'

BLOCK 4: IN ACCORDANCE WITH DI-SAFT-81563,

CONTRACTOR SHALL PROVIDE THE NAME AND

TELEPHONE NUMBERS OF ALL STATE, FEDERAL, AND

NAVY PERSONNEL CONTACTED REGARDING AN

INCIDENT. THIS INCLUDES BUT IS NOT LIMITED TO:

IDENTIFICATION OF THE SUBSTANCE LEAKED OR

SPILLED, LOCATION, DATE, QUANTITY, PERSONNEL

INJURY INVOLVED, CLEANUP PROCEDURES

IMPLEMENTED, NAME AND TELEPHONE NUMBERS OF

ALL STATE, FEDERAL, AND NAVY PERSONNEL

CONTACTED, AND DESCRIPTION OF CIRCUMSTANCES

SURROUNDING THE INCIDENT.

BLOCK 9: DISTRIBUTION STATEMENT "D" -

DISTRIBUTION AUTHORIZED TO DOD AND U.S.DOD

CONTRACTORS ONLY; CRITICAL TECHNOLOGY,

EXPORT CONTROLLED (4/5/2017). OTHER REQUESTS

SHALL BE REFERED TO PEO-SUBS (PMS404).

BLOCKS 10, 12 & 13: IF A LEAK OR SPILL OCCURS,

THE CONTRACTOR SHALL PROVIDE DATA REPORT

IMMEDIATELY, AS REQUIRED BY DI-SAFT-81563.

BLOCK 14: CONTRACTOR SHALL PROVIDE DATA BY

ELECTRONIC FORMAT (DOCUMENT OR PDF) TO

ON-SITE POC, PROCURING CONTRACTING OFFICER

(PCO), AND CONTRACTING OFFICER'S

REPRESENTATIVE (COR).

SEE CONTRACT CLAUSE G-242-H001 GOVERNMENT

CONTRACT ADMINISTRATION POINTS-OF-CONTACT

AND RESPONSIBLILTIES.

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Source: https://assist.dla.mil -- Downloaded: 2022-11-29T15:18Z

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

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

TDP TM OTHER

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

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

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

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

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

Draft

Final Reg Repro

16. REMARKS

15. TOTAL ▬▬▬▬►

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

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page of Pages

0009 A MGMT

HAZARDOUS WASTE PICKUP TBD

A002 HAZARDOUS WASTE REPORT N/A

DI-MGMT-82129 PWS PARA 2.6 N00253

LT

D

ASREQ ASREQ

N/A N/A ASREQ

PCO

ON-SITE POC 0

010COR

1 0

12/14/2023

14DEC2023

1 1

BARNES.ELIZABET

H.RAE.1594391230

Digitally signed by

BARNES.ELIZABETH.RAE.159439

Date: 2023.12.14 13:57:45 -08'00'

STIGLICH.PAUL.AN

THONY.1150153065

Digitally signed by

STIGLICH.PAUL.ANTHONY.11501

53065 Date: 2023.12.14 14:43:57 -08'00'

BLOCK 9: DISTRIBUTION STATEMENT "D" -

DISTRIBUTION AUTHORIZED TO DOD AND U.S.DOD

CONTRACTORS ONLY; CRITICAL TECHNOLOGY,

EXPORT CONTROLLED (4/5/2017). OTHER REQUESTS

SHALL BE REFERED TO PEO-SUBS (PMS404).

BLOCKS 10, 12 & 13: HAZARDOUS WASTE REPORT

REQUIRED FOR EACH PICKUP IN ACCORDANCE WITH

DI-MGMT-82129.

BLOCK 14: CONTRACTOR SHALL PROVIDE DATA BY

ELECTRONIC FORMAT (DOCUMENT OR PDF) TO

ON-SITE POC, PROCURING CONTRACTING OFFICER

(PCO), AND CONTRACTING OFFICER'S

REPRESENTATIVE (COR).

SEE CONTRACT CLAUSE G-242-H001 GOVERNMENT

DATA ITEM DESCRIPTION

Title: Hazardous Waste Report

Number: DI-MGMT-82129 Approval Date: 20170608

AMSC Number: N9814 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: MGMT-2017-026

Applicable Forms: N/A

Use/Relationship: The Hazardous Waste Report will identify type, amount, and disposal cost of hazardous waste removed during the period of performance. It will provide the Government with evidence of proper hazardous waste disposal.

This 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.

Requirements:

1. Format. The Report shall be in contractor’s format.

2. Content. The report shall contain:

2.1. Name, title, description, and quantity of each item.

2.2. Analysis used to identify the hazardous waste.

2.3. Copies of paid invoices and receipts for the disposal of hazardous wastes.

End of DI-MGMT-82129

Source: https://assist.dla.mil -- Downloaded: 2023-02-01T22:26Z

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

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

TDP TM OTHER

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

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

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

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

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

Draft

Final Reg Repro

16. REMARKS

15. TOTAL ▬▬▬▬►

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

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page of Pages

0009 A MGMT

HAZARDOUS WASTE PICKUP TBD

A003 CERTIFICATION DATA REPORT PERSONNEL QUALIFICATIONS

DI-MISC-82386 PWS PARA 5.2.1 N00253

LT

A

ASREQ ASREQ

N/A N/A ASREQ

PCO

ON-SITE POC 0

010COR

1 0

1/22/2024

22JAN2024

BARNES.ELIZABET

H.RAE.1594391230

Digitally signed by

BARNES.ELIZABETH.RAE.159439

Date: 2024.01.22 10:21:39 -08'00'

STIGLICH.PAUL.AN

THONY.1150153065

Digitally signed by

STIGLICH.PAUL.ANTHONY.11501

53065 Date: 2024.01.22 10:46:44 -08'00'

BLOCK 4: IN ACCORDANCE WITH DI-MISC-82386,

CONTRACTOR SHALL PROVIDE CERTIFICATIONS THAT

PERSONNEL HAVE SPECIFIC QUALIFICATIONS TO

PERFORM HAZARDOUS WASTE OPERATIONS

INCLUDING BUT NOT LIMITED TO HAZARDOUS WASTE

OPERATIONS AND EMERGENCY RESPONSE

(HAZWOPER) AND RESOURCE CONSERVATION AND

RECOVERY ACT (RCRA) TRAINING.

BLOCK 9: DISTRIBUTION STATEMENT A - APPROVED

FOR PUBLIC RELEASE: DISTRIBUTION IS UNLIMITED.

BLOCKS 10, 12 & 13: CERTIFICATION DATA REPORT

REQUIRED IN ACCORDANCE WITH DI-MISC-82386.

BLOCK 14: CONTRACTOR SHALL PROVIDE DATA BY

ELECTRONIC FORMAT (DOCUMENT OR PDF) TO

ON-SITE POC, PROCURING CONTRACTING OFFICER

(PCO), AND CONTRACTING OFFICER'S

REPRESENTATIVE (COR).

SEE CONTRACT CLAUSE G-242-H001 GOVERNMENT

DISTRIBUTION STATEMENT A. Approved for public release. Distribution is unlimited.

DATA ITEM DESCRIPTION

Title: CERTIFICATION DATA REPORT

Number: DI-MISC-82386 Approval Date: 20220712

AMSC Number: N10332 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: MISC-2022-003

Applicable Forms: N/A

Use/Relationship: The Certification Data Report is required to verify that specific qualifications have been obtained, tests have been performed, parts/assemblies/equipment/systems have been installed, tested, inspected and are ready for operation; that personnel have specific qualifications to perform assignments/operations/inspections; or to certify identicalness, interchangeability, compatibility, reliability, or completeness of documentation being prepared or reviewed by a contractor. The technical effort involved will be the result of equipment, procurement, or contract requirements.

This Data Item Description (DID) contains the format and content preparation instructions for the data product generated by specific and discrete task requirements as delineated in the contract.

This DID supersedes DI-MISC-80678.

Requirements:

1. Reference Documents: N/A

2. Format. The report shall be typewritten in narrative format. Contractor’s format is acceptable.

3. Content: The report shall contain the contract number and data item sequence number, and shall contain a statement that specifically identifies the purpose and applicability of this certification.

4. Technical Content: The technical content shall be in accordance with the appendix entitled

“Certification Data/Report Technical Content Requirements,” contained in the applicable military specification as stated in the DD Form 1423, Contract Data Requirements List. The technical content shall be as specified on the DD Form 1423, Contract Data Requirements List and the contract requirements.

5. Certification of Completion. Certification that tests have been performed, inspections made, parts/assemblies/equipments/systems have been installed, tested, inspected, and are ready for operation, or that specific qualifications have been obtained shall provide objective evidence in support of the certification. Objective evidence may include such items as spectrographs, radiographs, material sampling, analysis, inspection and testing reports, or any other necessary documentation.

Source: https://assist.dla.mil -- Downloaded: 2024-01-18T18:50Z

DI-MISC-82386

6. Certification of Personnel. Certifications that personnel have specific qualifications shall be supported by licenses, permits, tests, statements of competency, or other documentation. The specific capabilities to perform an assignment, inspection, or other operations shall be stated in the certification.

7. Certification of Compliance. Certification of compliance to specific specification requirements shall be a statement to the effect that the contractor has complied.

8. Supplemental Information. Additional specific material, drawings, sketches, photographs, etc., in support of these certifications shall be as defined in the DD Form 1423 and the contract requirements.

9. Signature. The Certification Report shall contain the signature of the contractor's authorized representative. Electronic signatures are acceptable.

End of DI-MISC-82386

Source: https://assist.dla.mil -- Downloaded: 2024-01-18T18:50Z