Exhibit A FINAL CDRLS N4215821Q0046.pdf

PREVENTATIVE MAINTENANCE PROGRAM (PM),

YEARLY CERTIFICATION AND CALIBRATION (C&C), AND

REMEDIAL MAINTENANCE FOR MACHINE SHOP EQUIPMENT

CONTRACT/PR NO.: N42158-21-RC-TBD 2021

DD FORM 1423-1, Rev B. Dated APR 2017

CONTRACT DATA REQUIREMENTS LIST (CDRL)

TABLE OF CONTENTS

ITEM SUBTITLE

A001 PREVENTATIVE MAINTENANCE SERVICE AND DIAGNOSTIC REPORT

A002 REMEDIAL MAINTENANCE REPAIR AND WORK COMPLETION REPORT

A003 CERTIFICATION AND CALIBRATION REPORT

A004 QUALITY MANAGEMENT PLAN

A005 INSPECTION & SURVEILLANCE SYSTEM AND FILE REPORT

A006 CERTIFICATE OF COMPLETION REPORT

REMEDIAL MAINTENANCE FOR MACHINE SHOP EQUIPMENT

CONTRACT DATA REQUIREMENTS LIST

(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

A

C. CATEGORY

TDP TM OTHER MGMT1

D. SYSTEM/ITEM

NNSY MACHINE SHOP EQUIPMENT-

BLDG 171 & BLDG 298

E. CONTRACT/PR NO.

N42158-21-RC-TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A001

2. TITLE OF DATA ITEM

SERVICE WORK REQUEST REPORT

3. SUBTITLE

PREVENTATIVE MAINTENANCE SERVICE AND

DIAGNOSTIC REPORT

4. AUTHORITY (Data Acquisition Doc. No)

DI-MGMT-81893 (SEE BLK 16)

5. CONTRACT REFERENCE

PWS PARA 4.5.1

6. REQUIRING OFFICE

NNSY C983

7. DD 250 REQ

LT

9. DIST STATEMENT

REQUIRED

D (SEE BLK 16)

10. FREQUENCY

ASGEN (SEE

BLK 16)

12. DATE OF FIRST SUBMISSION

ASREQ (SEE BLK 16)

14. DISTRIBUTION

SEE BLK 16

8. APP CODE

N/A

11. AS OF DATE

13. DATE OF SUBSEQUENT SUBMISSION

SEE BLK 16 ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK 4: TAILOR DID TO REPORT CONTENT AS REQUIRED WITHIN PWS PARA 4.5.1.

THE CONTRACTOR SHALL COMPLETE AND SUBMIT A PREVENTATIVE AND

COMPREHENSIVE DIAGNOSTIC REPORT FOR ALL EQUIPMENT/ MACHINES LISTED

IN TABLE 1 OF THE PERFORMANCE WORK STATEMENT (PWS). ADDITIONAL

FORMAT INSTRUCTIONS AND GUIDANCE CAN BE OBTAINED REFERENCING DI-

MGMT-80995 (MAINTENANCE SERVICE REPORT).

BLK 9: DISTRIBUTION STATEMENT D. DISTRIBUTION AUTHORIZED TO THE

DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY (CARRIER UNNPI)

(13JULY2016). OTHER REQUESTS SHALL BE REFERRED TO POC AT NORFOLK

NAVAL SHIPYARD, NORFOLK, VA LISTED WITHIN THE CONTRACT.

BLK 10, 11 & 13: REPORTS SHALL BE PROVIDED AS MAINTENANCE IS COMPLETED

FOR EACH OCCURANCE FROM START TO END OF PERIOD OF PERFORMANCE.

BLK 12: SUBMITTED 10 WORKING DAYS AFTER INITIAL OCCURANCE.

BLK 14: DATA SUBMISSION SHALL BE PROVIDED IN A DOWNLOADABLE

MICROSOFT OFFICE ACCEPTABLE FORMAT.

POCs:

NNSY C983: Russell Harris russell.r.harris.@navy.mil

NNSY C983 1

15. TOTAL

G. PREPARED BY

RUSSELL HARRIS

H. DATE

05/18/2021

I. APPROVED BY

J. DATE

17. PRICE

GROUP

18. ESTIMATED

TOTAL PRICE

mailto:russell.r.harris.@navy.mil

REMEDIAL MAINTENANCE FOR MACHINE SHOP EQUIPMENT

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

A

C. CATEGORY

TDP TM OTHER MGMT1

D. SYSTEM/ITEM

NNSY MACHINE SHOP EQUIPMENT-

BLDG 171 & BLDG 298

E. CONTRACT/PR NO.

N42158-21-RC-TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A002

2. TITLE OF DATA ITEM

SERVICE WORK REQUEST REPORT

3. SUBTITLE

REMEDIAL MAINTENANCE REPAIR AND WORK

COMPLETION REPORT

4. AUTHORITY (Data Acquisition Doc. No)

DI-MGMT-81893 (SEE BLK 16)

5. CONTRACT REFERENCE

PWS PARA 4.5.2

6. REQUIRING OFFICE

NNSY C983

7. DD 250 REQ

LT

ASGEN (SEE

BLK 16)

12. DATE OF FIRST SUBMISSION

ASREQ (SEE BLK 16)

14. DISTRIBUTION

SEE BLK 16 ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK 4: TAILOR DID TO REPORT CONTENT AS REQUIRED WITHIN PWS PARA 4.5.2.

THE CONTRACTOR SHALL COMPLETE AND SUBMIT A REMEDIAL MAINTENANCE

REPAIR AND WORK COMPLETION REPORT FOR ALL EQUIPMENT/ MACHINES

LISTED IN TABLE 1 OF THE PERFORMANCE WORK STATEMENT (PWS). ADDITIONAL

FORMAT INSTRUCTIONS AND GUIDANCE CAN BE OBTAINED REFERENCING DI-

MGMT-648 (CONDITION FOUND REPORT) AND DI-MGMT-81868 (REPAIR PARTS

REPORT).

BLK 9: DISTRIBUTION STATEMENT D. DISTRIBUTION AUTHORIZED TO THE

DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY (CARRIER UNNPI)

(13JULY2016). OTHER REQUESTS SHALL BE REFERRED TO POC AT NORFOLK

NAVAL SHIPYARD, NORFOLK, VA LISTED WITHIN THE CONTRACT.

BLK 10, 11 & 13: REPORTS SHALL BE PROVIDED AS MAINTENANCE IS COMPLETED

FOR EACH OCCURANCE FROM START TO END OF PERIOD OF PERFORMANCE.

BLK 12: SUBMITTED 10 WORKING DAYS AFTER INITIAL OCCURANCE.

BLK 14: DATA SUBMISSION SHALL BE PROVIDED IN A DOWNLOADABLE

MICROSOFT OFFICE ACCEPTABLE FORMAT

NNSY C983

H. DATE

18. ESTIMATED

REMEDIAL MAINTENANCE FOR MACHINE SHOP EQUIPMENT

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

A

C. CATEGORY

TDP TM OTHER QCIC1

D. SYSTEM/ITEM

NNSY MACHINE SHOP EQUIPMENT-

BLDG 171 & BLDG 298

E. CONTRACT/PR NO.

N42158-21-RC-TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A003

2. TITLE OF DATA ITEM

CALIBRATION CERTIFICATE/ REPORT

3. SUBTITLE

CERTIFICATION AND CALIBRATION REPORT

4. AUTHORITY (Data Acquisition Doc. No)

DI-QCIC-80798C (SEE BLK 16)

5. CONTRACT REFERENCE

PWS PARA 4.5.3

6. REQUIRING OFFICE

NNSY C983

7. DD 250 REQ

LT

SEE BLK 16

12. DATE OF FIRST SUBMISSION

SEE BLK 16

14. DISTRIBUTION

SEE BLK 16 ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK: ADDITIONAL FORMAT INSTRUCTIONS AND GUIDANCE CAN BE OBTAINED

REFERENCING DI-MISC-80678 (CERTIFICATION/ DATA REPORT).

BLK 9: DISTRIBUTION STATEMENT D. DISTRIBUTION AUTHORIZED TO THE

DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY (CARRIER UNNPI)

(13JULY2016). OTHER REQUESTS SHALL BE REFERRED TO POC AT NORFOLK

NAVAL SHIPYARD, NORFOLK, VA LISTED WITHIN THE CONTRACT.

BLK 10 & 11: REPORTS SHALL BE PROVIDED AS MAINTENANCE IS COMPLETED

FOR EACH OCCURANCE FROM START TO END OF PERIOD OF PERFORMANCE. THE

CONTRACTOR SHALL SUBMIT A COMPREHENSIVE DETAILED REPORT FOR ALL

CALIBRATION TEST, IAW PARAGRAPHS 4.5.1 & 4.5.2 OF PWS.

BLK 12: SUBMITTED 30 DAYS AFTER INITIAL OCCURANCE.

BLK 13: ANALYSIS OF INSPECTIONS SHALL BE ACCOMPLISHED ON EACH MACHINE

IN TABLE 1 AS APPLICABLE, WITHIN 30 DAYS OF CONTRACT AWARD AND YEARLY

THERE AFTER.

BLK 14: DATA SUBMISSION SHALL BE PROVIDED IN A DOWNLOADABLE

MICROSOFT OFFICE ACCEPTABLE FORMAT.

H. DATE

18. ESTIMATED

REMEDIAL MAINTENANCE FOR MACHINE SHOP EQUIPMENT

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

A

C. CATEGORY

TDP TM OTHER QCIC1

D. SYSTEM/ITEM

NNSY MACHINE SHOP EQUIPMENT-

BLDG 171 & BLDG 298

E. CONTRACT/PR NO.

N42158-21-RC-TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A004

2. TITLE OF DATA ITEM

QUALITY MANAGEMENT SYSTEM (QMS)

3. SUBTITLE

QUALITY MANAGEMENT PLAN

4. AUTHORITY (Data Acquisition Doc. No)

DI-QCIC-81794A

5. CONTRACT REFERENCE

PWS PARA 4.7.2

6. REQUIRING OFFICE

NNSY C983

7. DD 250 REQ

LT

N/A

12. DATE OF FIRST SUBMISSION

30DAC

14. DISTRIBUTION

30DAC

ASGEN ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK 9: DISTRIBUTION STATEMENT D. DISTRIBUTION AUTHORIZED TO THE

DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY (CARRIER UNNPI)

(13JULY2016). OTHER REQUESTS SHALL BE REFERRED TO POC AT NORFOLK

NAVAL SHIPYARD, NORFOLK, VA LISTED WITHIN THE CONTRACT.

BLK 11 & 12: THE CONTRACTOR SHALL DELIVER PLAN IN CONTRACTOR’S FORMAT,

SUBMITTED 30 DAYS AFTER CONTRACT AWARD.

BLK 14: DATA SUBMISSION SHALL BE PROVIDED IN A DOWNLOADABLE

MICROSOFT OFFICE ACCEPTABLE FORMAT.

H. DATE

18. ESTIMATED

REMEDIAL MAINTENANCE FOR MACHINE SHOP EQUIPMENT

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

A

C. CATEGORY

TDP TM OTHER QCIC1

D. SYSTEM/ITEM

NNSY MACHINE SHOP EQUIPMENT-

BLDG 171 & BLDG 298

E. CONTRACT/PR NO.

N42158-21-RC-TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A005

2. TITLE OF DATA ITEM

QUALITY ASSESSMENT REPORT

3. SUBTITLE

INSPECTION & SURVEILLANCE SYSTEM AND FILE

REPORT

4. AUTHORITY (Data Acquisition Doc. No)

DI-QCIC-81187

5. CONTRACT REFERENCE

PWS PARA 4.7.4

6. REQUIRING OFFICE

NNSY C983

7. DD 250 REQ

LT

SEE BLK 16

12. DATE OF FIRST SUBMISSION

30DAC

14. DISTRIBUTION

ASREQ (SEE

BLK 16)

13. DATE OF SUBSEQUENT SUBMISSION

ASGEN (SEE BLK 16) ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK 4: ADDITIONAL FORMAT INSTRUCTIONS AND GUIDANCE CAN BE OBTAINED

REFERENCING DI-QCIC-81110 (INSPECTION AND TEST PLAN) AND DI-NDTI-80809B

(TEST/ INSPECTION REPORT).

BLK 9: DISTRIBUTION STATEMENT D. DISTRIBUTION AUTHORIZED TO THE

DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY (CARRIER UNNPI)

(13JULY2016). OTHER REQUESTS SHALL BE REFERRED TO POC AT NORFOLK

NAVAL SHIPYARD, NORFOLK, VA LISTED WITHIN THE CONTRACT.

BLK 10, 11, 12 & 13: DATA SUBMISSION SHALL BE PROVIDED AS INFORMATION

BECOMES AVAILABLE AND UPDATED TO REFLECT CHANGES AS APPLICABLE

UNTIL THE END OF THE CONTRACT. THE GOVERNMENT MAY ADJUST THE

FREQUENCY OF THE SUBMITTAL BASED ON THE CONTRACTOR’S QUALITY OF

PERFORMANCE.

BLK 14: DATA SUBMISSION SHALL BE PROVIDED IN A DOWNLOADABLE

MICROSOFT OFFICE ACCEPTABLE FORMAT.

H. DATE

18. ESTIMATED

REMEDIAL MAINTENANCE FOR MACHINE SHOP EQUIPMENT

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

A

C. CATEGORY

TDP TM OTHER MGMT1

D. SYSTEM/ITEM

NNSY MACHINE SHOP EQUIPMENT-

BLDG 171 & BLDG 298

E. CONTRACT/PR NO.

N42158-21-RC-TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A006

2. TITLE OF DATA ITEM

WORK COMPLETION CERTIFICATION CERTIFICATE

3. SUBTITLE

CERTIFICATE OF COMPLETION

4. AUTHORITY (Data Acquisition Doc. No)

DI-MGMT-82061

5. CONTRACT REFERENCE

PWS PARA 4.7.5

6. REQUIRING OFFICE

NNSY C983

7. DD 250 REQ

LT

ASGEN (SEE

BLK 16)

12. DATE OF FIRST SUBMISSION

EOC

14. DISTRIBUTION

ASREQ (SEE

BLK 16)

13. DATE OF SUBSEQUENT SUBMISSION

ASGEN (SEE BLK 16) ADDRESSEES

Draft

Final

Reg Repro

16. REMARKS

BLK 9: DISTRIBUTION STATEMENT D. DISTRIBUTION AUTHORIZED TO THE

DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY (CARRIER UNNPI)

(13JULY2016). OTHER REQUESTS SHALL BE REFERRED TO POC AT NORFOLK

NAVAL SHIPYARD, NORFOLK, VA LISTED WITHIN THE CONTRACT.

BLK 10, 11 & 13: THE CONTRACTOR SHALL PROVIDE A CERTIFICATE OF

COMPLETION (COC) IN THE VENDOR’S FORMAT ATTESTING THAT WORK

COMPLETED MEETS ALL TECHNICAL REQUIREMENTS. AFTER MAINTENANCE AND

REPAIRS HAVE BEEN COMPLETED, THE COR, TPOC, OR DESIGNATED ALTERNATE

WILL CERTIFY THAT THE EQUIPMENT PERFORMS TO OEM STANDARDS AND SIGNS

THE SERVICE CALL TICKET.

BLK 14: DATA SUBMISSION SHALL BE PROVIDED IN A DOWNLOADABLE

MICROSOFT OFFICE ACCEPTABLE FORMAT.

H. DATE

18. ESTIMATED

TOTAL PRICE

mailto:russell.r.harris.@navy.mil