Exhibit A.pdf
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- Solicitation number
- W911PT26Q137
About this file
This is a Contract Data Requirement List (DD Form 1423) issued by the Department of the Army's Watervliet Arsenal, specifying three data items required from the contractor for contract line items 0001, 0003, 0005, and 0001-0006.
The first data item (A001) is a Test/Inspection Report documenting inspection records for a first article sample using WVA Form 702-61-R-E dated March 16, 2016. This report must be submitted with the first article and follows authority DI-NDTI-80809B. The contractor must delete paragraph 10.2 of the referenced Data Item Description and also submit DD Form 1222. The requiring office is TAWV-CQD-C CQD-E, with one final copy required for distribution to addressees specified in the contract or purchase order. The second data item (A002) is a Certificate of Conformance (COC) under authority DI-MISC-80678, submitted with each shipment to DEPARTMENT OF THE ARMY, Attn: TAWV-CQD-E, Bldg. 35-E, Watervliet Arsenal, 1 Buffington Street, Watervliet NY 12189-4000. The COC must reference specific materials, fabrication methods, or heat treat process characteristics and requires deletion of paragraphs 10.3 and 10.4 of the referenced Data Item Description. The third data item (A003) is an Inspection Records report for production components (CN12) under authority DI-NDTI-80809B, submitted with each shipment to the same Watervliet Arsenal address. This submission requires deletion of paragraphs 10.2 through 10.2.8 and must include all records for production components per QAP-APPX-WVA requirements. All three data items carry a Distribution Statement B (Test and Evaluation) and reference the QAP-APPX-WVA document for detailed requirements. The form was prepared by J Cannon and approved by William Potter, TAWV-CQD-E, on March 3, 2025.
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| File | Type | Posted |
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| Solicitation - W911PT26QA137 SAM.GOV.pdf |
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CONTRACT DATA REQUIREMENT LIST – DD Form 1423 Form Approval OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 440 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 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 to either 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.: 0001;0003;0005
B. EXHIBIT A
C. CATEGORY
D. SYSTEM/ITEM
E. CONTRACT/PR NO.:
F. CONTRACTOR
1. DATA ITEM NO: A001
2. TITLE OF DATA ITEM: Test/Inspection Report
3. SUBTITLE: Inspection Records – First Article Sample WVA FORM 702-61-R-E, 16 March 2016 702-CQD-E 61 8 Jan 2025(CN 3)
4. AUTHORITY: DI-NDTI-80809B
5. CONTRACT REFERENCE: First Article Clause
6. REQUIRING OFFICE: TAWV-CQD-C CQD-E
7. DD250 REQUIRED: *See Block 16
8. APP CODE:
9. DISTRIBUTION STATEMENT REQUIRED: B Test and Evaluation
10. FREQUENCY: ONE/P
11. AS OF DATE:
12. DATE OF FIRST SUBMISSION: With First Article
13. DATE OF SUBSEQUENT SUBMISSIONS: With First Article
14. DISTRIBUTION:
A. ADDRESSEES: As specified in contract or purchase order
B. COPIES:
DRAFT: 0
FINAL: 1
15. TOTAL: 1
16. REMARKS: Delete paragraph 10.2 of referenced DID (Block 4). Submit WVA Form 702-61-R-E showing results of inspections. Also submit DD Form 1222. Computerized versions of these forms may be used with prior approval of the procuring office. See QAP-APPX-WVA paragraph 10 for requirements. * Inspection/acceptance requirements specified in the contract. Data Item Description (DID) referenced in block 4 can be accessed at:
http//assist.daps.mil.
17. PRICE GROUP:
18. ESTIMATED TOTAL PRICE:
G. PREPARED BY: J Cannon H. DATE: 3 Mar 2025 I. APPROVED BY: William Potter, TAWV-CQD-E J. DATE: 3 March 2025
Public reporting burden for this collection of information is estimated to average 440 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 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 to either 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.: 0001-0006
B. EXHIBIT A
C. CATEGORY
D. SYSTEM/ITEM
E. CONTRACT/PR NO.:
F. CONTRACTOR
1. DATA ITEM NO: A002
2. TITLE OF DATA ITEM: Certification/Data Report
3. SUBTITLE: Certificate of Conformance (COC), General Application (CN 5)
4. AUTHORITY: DI-MISC-80678
5. CONTRACT REFERENCE: QAP-APPX-WVA and specific drawing requirement
6. REQUIRING OFFICE: TAWV-CQD-E
7. DD250 REQUIRED: No
8. APP CODE:
9. DISTRIBUTION STATEMENT REQUIRED: B Test and Evaluation
10. FREQUENCY: With Each Submission
11. AS OF DATE:
12. DATE OF FIRST SUBMISSION: With First Shipment
13. DATE OF SUBSEQUENT SUBMISSIONS: With Each Shipment
14. DISTRIBUTION:
A. ADDRESSEES: DEPARTMENT OF THE ARMY, Attn: TAWV-CQD-E Bldg. 35-E, Watervliet Arsenal, 1 Buffington Street, Watervliet NY 12189-4000
B. COPIES:
DRAFT: 0
FINAL: 1
15. TOTAL: 1
16. REMARKS: Delete paragraph 10.3, 10.4 of referenced DID (Block 4). See QAP-APPX-WVA paragraph 4.6 for the general requirement. The COC will also contain specific reference to any appropriate material, fabrication method or heat treat process characteristic. Data Item Description (DID) referenced in block 4 can be accessed at:
http//assist.daps.mil.
17. PRICE GROUP:
18. ESTIMATED TOTAL PRICE:
G. PREPARED BY: J Cannon H. DATE: 3 Mar 2025
J. DATE: 3 March 3, 2025
Public reporting burden for this collection of information is estimated to average 440 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 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 to either 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.: 0001-0006
B. EXHIBIT A
C. CATEGORY
D. SYSTEM/ITEM
E. CONTRACT/PR NO.:
F. CONTRACTOR
1. DATA ITEM NO: A003
2. TITLE OF DATA ITEM: Test/Inspection Report
3. SUBTITLE: Inspection Records, Production Components (CN12)
4. AUTHORITY: DI-NDTI-80809B
5. CONTRACT REFERENCE: QAP-APPX-WVA
6. REQUIRING OFFICE: TAWV-CQD-E
7. DD250 REQUIRED: No
8. APP CODE:
9. DISTRIBUTION STATEMENT REQUIRED: B Test and Evaluation
10. FREQUENCY: With Each Submission
11. AS OF DATE:
12. DATE OF FIRST SUBMISSION: With First Shipment
13. DATE OF SUBSEQUENT SUBMISSIONS: With Each Shipment
14. DISTRIBUTION:
A. ADDRESSEES: DEPARTMENT OF THE ARMY, Attn: TAWV-CQD-E Bldg. 35-E, Watervliet Arsenal, 1 Buffington Street, Watervliet NY 12189-4000
B. COPIES:
DRAFT: 0
FINAL: 1
15. TOTAL: 1
16. REMARKS: Delete paragraph 10.2 through 10.2.8 of referenced DID (Block 4).
Submit all records for production components. See QAP-APPX-WVA paragraph 4.2 and 4.5 for the requirement.
Data Item Description (DID) referenced in block 4 can be accessed at: http//assist.daps.mil.
17. PRICE GROUP:
18. ESTIMATED TOTAL PRICE:
G. PREPARED BY: J. Cannon H. DATE: March 3, 2025
J. DATE: March 3, 2025
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