Exhibit A. FA468624R0011 Contract Data Requirements List (CDRL) A.pdf

(COMPUTER GENERATED)

CONTRACT DATA REQUIREMENTS LIST

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A MGMT

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A001 REPORT, PRODUCTION OR DELIVERY PROBLEM(S)

CONTRACTOR

TBD

SUBTITLE

N/A

DI-MGMT-81178 SOW PARA - 4.6, 4.12.2, 5.6 SEE BLOCK 16

LT

N/A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 4: DID tailoring: Delete para 7.2. Para 10.2.1a Delete reference to system/component, hull tasks.

Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

Exhibit: A

DATA ITEM DESCRIPTION OMO NO. o w l m

2. mu - t 1. IDENTIFIUTION NUMBER

REPORT, PRODUCTION OR DELIVERY PROBLEM(s) DI-UGUT- 81 178

I 3.1 The report is used to inform the procuring activity of crises which have developed, or are developing, and which have the potential to stop, interrupt or severely impact the production or delivery of contract end items.

I 7.2 This DID is applicable to the acquisition, of both hardware and softvare systems, subsystems, components and equipment. It may be applied to any contract covering the acquisition of arpplies/services, the delive'ky of vhich, if stopped I

(continued on page 2) -

I (continued on page 2) I

4. WPROVAL DATE

WMMOO)

910328

J

WPROVAL U M K A T O N )b. AM% NUMBER

86094

1 10.1 Fonat. The report shall be in contractor forut. I

7 . 4PPUCATK)N I INTERREUTIONSMIP

7.1 This data item description (DID) contains the format'md content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

I 10.2 Content. The report shall contain the folloving: I

6b. GIDEP REOUIRED 5. OFFICE OF PRIMARY RESPONSIBILITY (OPR)

N/SEA 06D32

1 10.2.1 Identification. The first page of the iceport shall contain the follaving: I

6a. OTlC REQUIRED

a. Identification of the ~stem/component/progrum/project/hull/activity involved.

b. Contract Number.

c. Preparing activity.

d. ~erial/identification number (assigned by the preparing activity), and the date.

e. Security classification, when required.

10.2.2 Body of Report. The report shall contain a complete, but concise, explanation as to the nature and cause of the crisis or problem and the current or potential impact on contract end item production, delivery, cost or scheduling.

In addition, the report shall include the folloving as applicable and appropriate:

I (continued on page 2) I DIS1RlBUTK)N STATEMENT I

Distribution Statement A: Approved for public release; distribution is limited.

L DO Form 1664. JUN a m * o y ~ d o o I--(. ~ u ; r or 2 PAGES

./PI 0102- '-0014641

88 -*I l-I.C.(.CIP I..* .a,. ,"*.,4.a:p

FA468624R0001

Block 3, DESCRIPTION/PURPOSE (continued)

3.2 Examples of such crises are: accidents, strikes, subcontractor or vendor difficulties or slippage, shortage of material, transportation tie-ups, or other potential bottlenecks vhich may impact contract end item production or delivery.

Block 7, APPLICATION/INTERRELATIONSRIP (continued) or interrupted, vill adversely.effect a military program, project or operation, or the construction, conversion, overhaul, alteration or maintenance of military ships, systems or equipment.

Block 10, PREPARATION INSTRUCTIONS (continued)

a. Action(s1 Taken. Describe contractor action(s) taken to remedy the crisis or problem. If no contractor action-has been taken, provide a brief explanation.

b. Action(s1 Required. Clearly indicate the action(s) required, the date by which the action is required, and the responsible party, e.g., contractor, procuring activity, other agency or activity.

c. Revised Data. Revised/updated production, delivery, cost or scheduling data should be provided, if available.

d. Contractor Recommendations. Delineate contractor recotmendation(s), if any, to solve the current crisis or problem, to prevent a recurrence, or for procuring activity follorup.

e. Appendices. Tables, references, charts or other descriptive material or information that will clarify the crisis or problem, or that will support the rationale for contractor recommendations, if any, should be provided as appendices. Each appendix ahall be identified and referenced in the appropriate area of the report.

10.2.3 Report Preparer. Name and telephone number of the person(8) preparing the report.

page 2 of 2 pages

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A MISC

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A002 ENVIRONMENTAL PERMITS

CONTRACTOR

TBD

SUBTITLE

N/A

DI-MISC-81274 SOW PARA - SEE BLOCK 16 SEE BLOCK 16

LT

N/A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 5: PWS Paragraphs: 4.7, 6.1.2, 6.1.5, 6.2, 7.1.1, 7.1.2, 7.1.3, 7.1.4, 7.1.5, 7.1.6 Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

DATA ITEM DESCRIPTION I Form &proved OMB iva. o m - o ~ e e I

I

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1. TITLE 2, IDEYTlFlCLLTlON NUMBER

I

3 . DESCRIPTION IPUAPOSE I

3.1 Thin 4ata i d e n t i f i e 6 s p e c i f i c snvfromnental permitting appliua-t i o n s required for propoeed Government aotions. ~ p p l i c a t i o n s prepared w i l l be submitted an specified f o r procensing.

7.1 The Data Item ~ e s c r i p t i o n ( D I D ) contains the f e n a t and e ~ n t e n t preparation ins t ruc t ions f a r the data ptoduct generated by the speo i f i c and d ina re te t aak requirement as delineated in the d on tract.

3-2 his da ta v i l l be uaed as au thor i ty t o cranstruat or operate sites.

I 7 . 2 ~ p p l i c a b l e t o a l l can t rac t s requiring environmenta2 permit r e e p o n s i b i l i t i e s an delineated i n t h e aontract .

1 0 . 2 c p n t e n t . Permits a h a l l be prepared as follow8:

6b. GIDEP APPLltABLE FFiCE OF PRIMARY RESPONSIBILITY (OPR)

920724 F/AFSPACECOH-CEPV

10.2.1 &uthor&y to Construnt (ATCI Permits: I n accordance with t h e rules and regula t ions of t h e EPA, Btate, Loaal, and Regional d i s t r i c t s .

7. APPLICATION I INTERRELATIONSHIP

a. DTIC '&~PLICABLE

10.2..2 Pernits to operate: I n aacardanae with t h e r u l e s and regula t ions af the EPA, Btate, Local, and Regional d i s t r i c t s .

10.2.3 npecsific ~~rmits.: Req~iXvtd environmental permits s h a l l inulude the following, as appliaabls: air &ssiuas, dredge and f i l l , s tomwater , domeatfa wastewater, i n d u e t r i a l wastewater, potable water, water W e l l % , ~ o l i d waste, and hazardous waste.

I.

f 1 1 . PlSTRlBUTlON STATEMENT I DISTR~BWTION BTATEXEHT A. Approved f o r publ ia reltvase: distr5butioa is unlimited.

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A MISC

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A003 SCIENTIFIC AND TECHNICAL REPORTS

CONTRACTOR

TBD

SUBTITLE

OSHA REPORTS

DI-MISC-80711A SOW PARA - 4.11.1 SEE BLOCK 16

LT

A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A MISC

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A004 SCIENTIFIC AND TECHNICAL REPORTS

CONTRACTOR

TBD

SUBTITLE

HAZARDOUS MATERIALS/WASTE DISPOSAL

REPORT

DI-MISC-80711A SOW PARA - 4.11.2, 4.15.2F SEE BLOCK 16

LT

A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A MISC

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A005 SCIENTIFIC AND TECHNICAL REPORTS

CONTRACTOR

TBD

SUBTITLE

SEE BLOCK 16

DI-MISC-80711A SOW PARA - SEE BLOCK 16 SEE BLOCK 16

LT

A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 3: Will be specified at task order level.

Block 5: SOW Paragraphs: 4.12, 4.15.2A, 4.15.2I, 4.15.2O, 4.15.2P, 4.15.2Q, 5.2.1, 5.2.3, 5.3, 5.4, 5.5, 5.6, 6.1.2, 6.1.3, 6.1.4, 6.1.5, 6.2, 7.1.1, 7.1.2, 7.1.3, 7.1.4, 7.1.5, 7.1.6 Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A ENVR

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A006 ENVIRONMENTAL HEALTH AND SAFETY PLAN (HSP)

CONTRACTOR

TBD

SUBTITLE

N/A

DI-ENVR-81375 SOW PARA - 4.13 SEE BLOCK 16

LT

A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

DA'PA ITEM DESCRIPTION

I Environmental Health and Safety Plan (HSP) I Dl-ENVR-81375

I

3. DESCRIPTION l PURPOSE

1 3.1 The plan describes the Conuactor's procedures for ensuring health and safety standards. I

I 3.2 The plan serves as the basis for validation of the health aria safety standards to be Rnpkmented in acoDrdance with1 29 Combined Federal Regulation (CFR) 1910.120. I

7.1 This Data Item Desaiption (DID) contains the f o m t and content preparation instructions for the data product generated by the spatic and d i task requirement as delineated in the contracL 72 This DID is applicable when contractors are msponsibb for the ckwqment of p r o d u n s for health and safety requiremnts.

7.3 U.S. Environmental Protec!ion Agency (EPA) G u i i for Conducbng Remedial Investigations and Feasibility Shrdies Under Comprehensive Environmental Rcsponsc, Compensation, and Liobli Ad (CERLCA) can be obtained from: U.S. EPA, Omee of Emergency and Remedial Response. Washington DC 20460.

10.1 -. The applicable hrue of um documem ded herein. indudi Mi apprrnral dates and dates of any applicable amendments. nokes and rarision. $hall bs as specmod in the centrad I

10.3 Cantent. The HSP shall amt i n the folknring (addbnal informetion can bs obtained frwn U.S. EPA W i n e for Cnnducbng Remedial Investgations and FeasWty Studi Under CERCLA): I

4 APPROVALDATE

m ( - I

931216

a. IdernimbIl oi tite bcotiorr.

b. Sumw9ncs of r ; i h i .

C. &lWX$bS~ E'~B B ? d d .

d. FbnrCd aChi&s.

DD Fom 1564, APR 89 (EF) J tarm chvplrr.dylb~~~--. p.9.10l3pgl m.

7 APPUUllON I INTERREUllONtnIP

00 GlMPAPPLlCABLE 5 OFFICE OF P W Y RESPONSBIUW (OPR)

FIAFCEE-ESK

6m DnC APPLICABLE

FA468624R0001

Block 10, Preparation Instruchons (Continued)

10.3.2 -. The organization required to support the health and Safety function shall include:

a. Descnptlon of the program and project safety organization Structure

b. Identification of safety program members.

c. Description of tesponsibilitres of the safety program members.

d. Telephone number for each safety pmgrarn member.

10.3.3 Skrna~2. The plan shall include a site map to depict all details relevant to heam and Safety:

a. ldentrfy zones of exclusion.

b. ldentrfy work staging areas.

c . ldentrfy decontamination areas.

d. Idenbfy location of alarms.

e. ldenbfy emergency response equipment locations.

f. Identify site entrances and exits.

g. ldentrfy evacuation routes.

h. Location of telephones.

10.3.4 -. Identification of potential heatth and safety risks for each task and operation includtng:

a. Site amtaminants and hazardous materials that ere planned for ort4te use.

b. An appendix referencing material safety data sheets for sach chemical hazard.

10.3.5 w. The plan shall indude a statement of each mwkefs Occupational Safety and Heah Administration (OSHA) mining status under 29 CFR 1 B1 (F12O.

a. Identification of the lime, bcation, and subject matter of aita vdcer mining sessions.

b. A schedule fo r th pre-entry briefings held p* to initiating on-site activities.

10.3.6 -. An identification of the pcnonal pmkbw equipment to be used by on-site employees for each protection level that shall be requid including:

a. Equipment tern pmcedums and f r e q w .

b. Decontamination procedums and frequency.

10.3.7 Mcd,eal. Desmibe the medical wdUance program to be impbmetnted to sown and monitor site personnel.

10.3.8 m. Identify the mitoring procedums to ensure the safety of sibb personnel and ths public including:

a. The frequency of, and methods to be used to monibx ambient air, site personnel. and environmental media.

b. lmmentation, talibration, and qbliility conW pradkes.

c. Action kvels 8swSatd with cack monibDmd parameter.

d. Informstion to support the action level sektud.

Page 2 a13 Pages

FA468624R0001

Block 10, Preparation InsWctions (Continued)

10.3.9 Site Identify the procedures for controlling access to restricted areas and prevent"% wntarnrnatron of clean areas and srte personnel ~ncludng.

a. Areas that require the use of personal pt~tective equipment on a site map.

b. The steps to be taken to ensure safe worlong condibons and communicabon among Site personnel.

c. Confined space entry procedures.

10.3.10 m. The safety prahces, preparedness procedures, emergency telephone numbers and emergency response and follow-up for each site hazard identified in the HSP tncludrng:

a. The response action appropriate to all potential emergencies, spills, or contaminant releases.

b. Lecation and use of emergency response equipment, personnel, and sewices as well as the system for contacting response personnel in event of emergency.

c. Identification of all regulatory agenues nequiring notification of an emergency response including me system used for contacting regubtory authorities in the event of an emergency.

d. Outline of the emergency response documentation requirements necessary in the event of an emergency.

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A QCIC

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A007 QUALITY SYSTEM PLAN

CONTRACTOR

TBD

SUBTITLE

QUALITY SYSTEM PLAN

(QSP)

DI-QCIC-81449 SOW PARA - 4.14, 5.2.1 SEE BLOCK 16

LT

A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 4: DID tailoring:

10.3 Format. This plan/report shall be typewritten on standard size (i.e., 8 1/2" by 11") white paper or in electronic format as specified in individual task orders. Pages shall be sequentially numbered. All attachments shall be identified and referenced in the text of the report/plan. The report plan shall be legible and suitable for reproduction.

10.4 Content. The construction quality control plan/report shall include the following elements: a) Responsibility and authority - The responsibility and authority of all pertinent organizations. b) Construction quality assurance personnel qualifications. c) Inspection activities. d) Monitoring tests and observations. e) Sampling requirements. f) Any required documentation.

Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

Source: https://assist.dla.mil -- Downloaded: 2015-05-08T19:25Z Check the source to verify that this is the current version before use.

FA468624R0001

FA468624R0001

FA468624R0001

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A MGMT

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A008 TECHNICAL AND MANAGEMENT WORK PLAN

CONTRACTOR

TBD

SUBTITLE

CONSTRUCTION WORK

PLAN

DI-MGMT-81117 SOW PARA - SEE BLOCK 16 SEE BLOCK 16

LT

A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 5: SOW Paragraphs: 4.15.1, 5.2.1, 5.5, 7.1.1, 7.1.2, 7.1.3, 7.1.4, 7.1.5, 7.1.6 Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

DATA ITEM DESCRIPTION .

7 . 2 This DID may be used on any contract which is delivery order oriented.

Form P l E r n * d OYI ~a 0 7 w r u 8

I. APPROVAL wc Cvr-I

901219

10.1.1 -. Tha plan shall identify the contractor@s m e contract number, t i t l e and number of #e delivery or task ,order, security classification of the plan, name o f contract uonitor, an8 t h e Government office irauing the: tasking. .

, n u

TECHNICAL AND W A G E H E N T WORK PLAN

- '. U F W A T K ) n : W T E R 4 U 1 ~

7.1 his Data Item Description (DID) contains the format and content preparation instructions for the data product generated by the specifi and discrete task requirement as delineated in the contract.

s. c ;WE OF mm*rrr asmwmrun mm

X0.1.2 -material. The plan shall include descriptive matariaX, isyetem diagrams, sNtchee, photographs, tablea, forms, graphs, worksheets, char-, drawings, eto., a6 required. l0.r -. The plan shall be typewritten or printed on 8 1/2 11 ch paper. The pages &all be sequentially numbered and securely bound together. As nrceooary, graphic material may be one-way foldouts. A l 1 attachment6 shall be identified and referenced in khe text. Each sectfon and paragraph 8hall be numbered.

10.1.4 Tablg. plans of more than 30 pagea in

length shall contain a table of conkmts.

I. IDWWIUTON N U H ~ E ~

Dl-Mm-81117

9k *rrK NUlJlu

A6003

L UM0u.L UMlTAWM

( ~ o n t h u e d on Page :

1. DLSaiPrKIMlhlRmLE

3,1 The Technical and Hanagement Work Plan describes the contractor's plan to implement.the Statement of Work (SOW) tasking provided via delivery order or tasl order.

4#. OX UIUL~BLC

la rwutam wgtlstrnosa

10.1 -. The plan shall be subm%tted in a contractor devised and Government approved format w h i c h conforass to the following:

hu.rrPuwcrHIIIM5

I I . OtLlWuMW RATSMEW

DISTRIBUTION STATEMZNT A: approved for public release; distribution j unl hi ted .

WWDCC ACCUCAUE

FA468624R0001

Block lo, preparation Instructions (Continued)

10.1.5 s e a i b i l a . The document s h a l l be legible and reproducible.

10.2 C ~ n t e n t . The plan shall include information necessary to substantiate the-.contractor's approach t o completing the delivery or task order and information necessary f o r the Government to assess the soundness Of the contractor's approach. The plan shall contain the following:

10.2.1 -at- structw. The plan sha l l include a d e ~ c r i p t i a n of the contractor8s organizational structure and assignment of functions, duties, and respons ib i l i t i es which vill be assigned i n Support of the tasking. Additionally, the plan s h a l l ident i fy the contractorrs procedures, policies, and raport5ng requirements established t o i n i t i a t e , monitor, control, complete, and report on a c t i v i t i e s required of the delivery or tack order.

10 .2 .2 m a t f o t l a l interfaces. The plan sha l l describe a l l interfaces between the contrackor and the Government and between the contractor and other contractors or subcontractors which are necessary to complete the asmigned tasking. This shall include a descr ipt ion Of the applicable respons ib i l i t i es and functional re la t ionships betveen those organizations.

10.7 .3 pethod01 . The plan s h a l l include a narra t ive descr ipt ioh c lear ly d e f i n i n g z e t a c h n i a l approach (or method) Including toole, standards, and procedures to be wed by the contractor t o accomplish the delivery or task order, All d-antation, ac t iv i ty , or decisions required from the Government or ather GaverrrsPent contractor shall ha identified.

10.2.4 perso-. .The plan s h a l l identify the nmas and types of persome1 assigned to acconrpliah the delivary or.'LPsk order, .The plan shall show how the conbination of people assigned t o each task provides a su f f i c i en t knowledge or' experience base for that task. This includolu identifying any spec ia l education, training, experience, or skilla of these individwlci. Also, any spacial a&d.nistrative support requlrwnents oha l l be ident i f ied.

10.2.5 Securitu. The plan ohall identify any special or unique secur i ty requirements resulting from the delivery o r task order.

10,Z.L Sched . me plan ~bl l include a milastone chart(8) graphically d 3 c t i n g the schedule of eveintc aseooiateid with tbe delivery or task order, 'l!b lwel of d e t a i l s h a l l be eufficient to clearly show h w each eubtaok shall be pcrfozmod. his inoludee:

Page 2 of 3 Pages

FA468624R0001

Block lo, Preparation Instructions (Continued)

a. contractor activities.

b. Contractor deliverances (interim and final], including briefings (if required).

c, Other program milestones as appropriate (including Government input in 10.2.3 above).

dm Periodic milestones to allow adequate Government review of contractor progress.

10.2 7 The plan shall include a resources chart that graphically and numerically identifies the contractor's total planned manhour level of effort (WE) and LoE by month for each subtask identified in the delivery or task order. Proposed monthly aubtask manhour6 mhall be br~ken out by labar m ate gory in support of the dolivery or task order.

10.2.8 a The plan shall include a list of the travel requirements that shall include the following for each trip:

a. Company ar Govemnmt agency visited.

b. Location.

c, Number of travellers by labar category.

Trip dust ion.

10.2,9 contract= reauested data. Tbe plan shall include the contractor's best assessment of any additional data required by the contractor. This liet shall be as detailed as-poaarible and shall include document titles, respansible Government organizatione, anB reeponsjble Gavernment contractors. The criticality of each data required ahall be identified.

1D.2.10 Pelfverables. The plan shall include a brief description of the content8 of eacb deliverable to be provided as a result af the delivery or task order.

Page 3 of 3 Pages

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A MISC

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A009 SCIENTIFIC AND TECHNICAL REPORTS

CONTRACTOR

TBD

SUBTITLE

CONSTRUCTION COST ESTIMATES

DI-MISC-80711A SOW PARA - SEE BLOCK 16 SEE BLOCK 16

LT

A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 5: SOW Paragraphs: 4.15.2B, 6.1.2, 6.1.5, 6.2, 7.1.1, 7.1.2, 7.1.3, 7.1.4, 7.1.5, 7.1.6 Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A MISC

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A010 SCIENTIFIC AND TECHNICAL REPORTS

CONTRACTOR

TBD

SUBTITLE

SITE/PROJECT SUMMARY

DI-MISC-80711A SOW PARA - 4.15.2C, 5.3 SEE BLOCK 16

LT

A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

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

TDP TM OTHER

D. SYSTEM/ITEM F.

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0001/1001/2001 A MGMT

GC MATOC Beale AFB

E. CONTRACT/PR NO.

FA468624R0001

A011 STATUS REPORT

CONTRACTOR

TBD

SUBTITLE

DAILY TECHNICAL/FIELD

REPORTS

DI-MGMT-80368A SOW PARA - 4.15.2D SEE BLOCK 16

LT

N/A A

BLK16

I. APPROVED BY

02/07/20249CONS/ Cali McVay

N/A

02/07/2024

9CES/* * * *

9 CONS/PKA* * * *

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

Block 4: DID Tailoring: Paragraph 3.2 in it's entirety is not applicable.

Block 6: Will be specified at task order level.

Blocks 10, 11, 12, & 13: Submissions and dates will be as specified at task order level.

Blocks 14 & 15: "*" will be specified at task order level. Quantity of required copies, Additional addresses and deliverable media, i.e. Hard Copy, e-mail, CD-ROM, etc., shall all be identified at task order level. E-mail addresses will be provided on a different cover letter.

Block I: Signature authority is evidenced by Contracting Officer signature on the basic contract award document. Individual task orders shall have signatures.

Block J: On the basic contract, this shall be the award date; however, approval dates shall be inserted for individual task orders.

1 1

FOR OFFICIAL USE ONLY

FA468624R0001

DATA ITEM DESCRIPTION

Title: Status Report

Number: DI-MGMT-80368A Approval Date: 30 OCT 2006 AMSC Number: 7619 Limitation: N/A DTIC Applicable: No GIDEP Applicable: No Office of Primary Responsibility: NS/DA02 Applicable Forms: N/A

Use/relationship:

The Status Report documents the status of contractor effort towards achieving contract objectives. It identifies accomplishments to date and difficulties encountered, and compare the status achieved to planned goals and the resources expended. It is used by the Government to monitor and evaluate contractor performance.

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

It is not intended that all requirements herein should be applied to every program.

Portions of the DID are subject to tailoring by deletion depending on the specific status reporting requirements of the project.

This DID is related to DI-FNCL-80331, Funds and Man-Hour Expenditure Report which can be used in conjunction with this report if paragraph 3.2.3 below is deleted.

This DID supersede DI-MGMT-80368.

Requirements:

1. Reference documents. None.

2. Format. The Status Report shall be in contractor format.

2.1 Identification. The data indicated below shall be contained on a title page or on the first page of the report.

a. Title/identification of the system/component/program/project.

Source: https://assist.dla.mil -- Downloaded: 2015-08-12T16:52Z Check the source to verify that this is the current version before use.

FA468624R0001

DI-MGMT-80368A

b. Type of report (e.g., monthly, interim, final).

c. Period covered by the report.

d. Contract number.

e. Preparing activity or contractor’s title.

f. Security classification, when required.

g. Distribution Statement.

2.2 Page size. The report shall be on 8 ½ by 11 inch (metric A4) paper.

3. Content. The report shall contain the following:

3.1 Summary. The summary shall include a brief statement of the overall project status , covering the accomplished technical activities and development, objectives of efforts, summary results of efforts, identification of major problems/deficiencies with impact, and recommended solutions.

3.2 Body of report. The Status Report shall contain the following items, where applicable:

3.2.1 Milestone/task status. The status of each milestone/task as defined by the statement of work or contract, as applicable:

a. A statement as to whether or not the program/project/task is on schedule; if not, the effort planned to meet the schedule shall be indicated. Include an overall status of each milestone, task, or unit of work. Include update schedule sheets, milestone charts, or task synopsis sheets identifying phase of task and percentage of completion of each task, technical instruction, or order.

b. A comparison of achieved end-product performance capabilities projected against contract baseline values, requirements, or allocations.

c. Effort expended on each task to date, and a brief description of technical developments and accomplishments.

d. Key dates in any testing program and description of tests performed and significant test results. If applicable, a description of the amount and type of down time on the equipment or system under test.

e. A list of all designs completed and a brief description of each item.