Exhibit CDRL A004 CONTRACTOR PEROM STATUS REPORT SURFACE COMS FINAL DRAFT RFP R2 13 OCT 2023.pdf

RFP N61340-23-R-0064

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:

A. LOT I-V TDP TM OTHER LOGISTICS DATA/COMS/CMS/TSM

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

FTSS V - SURFACE COMS N61340-23-R-0064 TBD

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

17.

PRICE GROUP

A004 TECHNICAL REPORT – STUDY/SERVICES

COMS/CMS MONTHLY CONTRACTOR PERFORMANCE

REPORT/ TRAINER SUPPORT EFFECTIVENESS

REPORTS

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

ESTIMATED

TOTAL PRICE

DI-MISC-80508B

PWS ADDENDUM A, PARA 4.5, 5.3.6,

5.4.2, 5.4.12.3, 5.4.22.1, 5.10.2, 5.16.6

NAWCTSD COMS

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

LT

MTHLY SEE BLK 16

a. ADDRESSEE

b. COPIES

8. APP CODE

D

11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

SEE BLK 16 Reg Repro

16. REMARKS SEE BLK 16 (Cont)

1. BLK 4: ONLY DID PARAGRAPH 3(C)(2) APPLIES. SEE ANNEX TO EXHIBIT A004 FOR SAMPLE

REPORT CONTENTS. ANNEX PARAGRAPHS 2.1, 2.2, 2.3, 2.4 & 2.5 (PARTS I-V) APPLY.

2. BLK 12: FIRST SUBMISSION SHALL BE REQUIRED ONCE A MONTH FOR THE PERIOD

BETWEEN TASK ORDER CONTRACT SUPPORT DATE (CSD) THROUGH THE END OF THE

CONTRACTED SERVICES. EACH TRAINING EQUIPMENT GROUP/DEVICE SHALL BE ADDRESSED

IN THE REPORT.

3. BLK 13: SUBSEQUENT SUBMISSIONS SHALL BE DUE TO THE SITE COR FOR SIGNATURE

THE 5TH WORKING DAY AFTER THE END OF EACH MONTHLY REPORTING PERIOD. FINAL

SUBMISSION SHALL BE DUE THE LAST WORKING DAY OF CONTRACTED SERVICE. REPORT

DISTRIBUTION SHALL BE DUE TWO (2) WORKING DAYS AFTER THE COR SIGNATURE.

4. THE GOVERNMENT WILL HAVE THIRTY (30) WORKING DAYS FROM RECEIPT OF

SUBMISSION FOR REVIEW AND ACCEPTANCE/REJECTION OF EACH SUBMISSION. NO

RESPONSE WILL INDICATE ACCEPTANCE.

5. BLK 14: REPORTS FOR COR ADDRESSES SHALL BE DISTRIBUTED TO ONLY THE

RESPECTIVE COR’S SITE. THE SUBMITTED REPORTS SHALL BE SENT VIA EMAIL. ALL

APPLICABLE EMAIL ADDRESSES FOR DISTRIBUTION (BLOCK 14) SHALL BE ON EACH

SUBMISSION. EMAIL SUBJECT LINE SHALL INCLUDE CONTRACT/TASK ORDER NUMBER, CDRL

DATA ITEM NUMBER, LOCATION AND PERIOD (E.G., E.G. N61340-14-D-0000-TO0003-A004-

LEMOORE-MAY-14). ALL REPORTS SHALL BE ATTACHMENT FILES TO THE EMAIL. ALL

REPORTS SHALL BE IN MICROSOFT OFFICE© 2016 EXCEL FORMAT. FILES AND DATA CELLS

SHALL NOT BE LOCKED OR PASSWORD PROTECTED. FILES SHALL NOT INCLUDE HIDDEN

DATA AND SHALL BE PREPARED AT UNDER ONE MEGABYTE SIZE WHERE PRACTICAL. EMAIL

ADDRESSES ARE PROVIDED IN THE CONTRACT SCHEDULE AND/OR THE CDRL ADDRESSEE

LIST (ATTACHMENT 4 OF THE CONTRACT).

6. BLK 9: THE FOLLOWING STATEMENT SHALL BE THE ONLY RESTRICTION MARKING

INCLUDED ON THE DELIVERABLE:

DISTIBUTION D: DISTRIBUTION AUTHORIZED TO DOD AND U.S. DOD CONTRACTORS ONLY,

(ADMINISTRATIVE OR OPERATIONAL USE), (04 JULY 2023). OTHER REQUESTS FOR THIS

DOCUMENT SHALL BE REFERRED TO THE COMMANDING OFFICER, NAVAL AIR WARFARE

CENTER, TRAINING SYSTEMS DIVISION, (GT43200), 12211 SCIENCE DRIVE, ORLANDO, FL

32826-3275.

15. TOTAL 9 0 33

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

M.A. GREEN SURFACE COMS DAPML S. SANTIAGO SURFACE COMS PJM

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 1 of 2 Pages

10/13/2023

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT

A-LOT I-V

C. CATEGORY:

TDP TM OTHER LOGISTICS DATA/COMS/CMS/TSM

D. SYSTEM/ITEM

FTSS V - SURFACE COMS

E. CONTRACT/PR NO.

N61340-23-R-0064

F. CONTRACTOR

TBD

16. REMARKS (Cont)

7. BLK 14: DISTRIBUTION

DISTRIBUTION

Appendix Copies

Final

Addressee / Location Draft Reg Repro

NAWCTSD PJM 1 1

NAWCTSD APJM 1 1

NAWCTSD TOM LEAD 1 1

NAWCTSD TOM I 1 1

NAWCTSD TOM II 1 1

NAWCTSD TOM III 1 1

NAWCTSD PCO 1 1

NAWCTSD CS I 1 1

NAWCTSD CS II 1 1

COR EWTGLANT, Little Creek, VA A-1 1

COR SWSC DET Norfolk, VA A-2 1

COR EWTGPAC, Coronado, CA A-3 1

COR SCSTCSD San Diego, CA A-4 1

COR SCSTC Unit, Dam Neck, VA A-5 1

COR NSST/Other Various Loc. A-6 1

COR NSST MSTC EAST Norfolk, VA A-7 1

COR NSST MSTC WEST, San Diego, CA A-8 1

COR SWSC DET San Diego, CA A-9 1

COR SWSC DET, Mayport, FL A-10 1

COR COMS NAVSTA, Great Lakes, IL A-11 1

COR SWSC / SCSTC DET Sasebo, Yokosuka, JP A-12 1

COR SWSC / SCSTC DET PACNORWEST, Everett, WA A-13 1

COR SWSC / SCSTC DET Pearl Harbor, HI A-14 1

COR COMS Newport, RI A-15 1

COR TTE NAVSTA Great Lakes, IL B-1 1

COR TTE San Diego, CA B-2 1

COR TTE Norfolk, VA B-3 1

COR LCS LTF, San Diego, CA C-1 1

COR LCS LTF, Mayport, FL C-2 1

COR MTF, Jacksonville, FL C-3 1

COR RTC Great Lakes, IL C-4 1

COR DDG-1000, ZTF, San Diego, CA C-5 1

COR MWTC, San Diego, CA C-6 1

Total 9 0 33

DD FORM 1423-1, FEB 2001 Page 2 of 2 Page

ANNEX TO EXHIBIT A004

CONTRACTOR COMS/CMS PERFORMANCE AND

TRAINER SUPPORT EFFECTIVENESS REPORTS

FTSS V CDRL REQUIREMENT

1.0 Report Contents.

1.1 Header Information. Data elements to be provided as header information are as follows, in the order shown.

a. Contract. Enter appropriate contract number.

b. Task Order. Enter appropriate task order number.

c. Contractor. Enter name of contractor's firm.

d. Reporting Period. Enter the start and completion dates for the contract/task order period the report is being prepared using a

DDMMMYY numerical format for each date.

1.2 Report Body.

1.2.1 General. This report documents summarizes status and contractor performance of a task order’s period of performance for the Fielded Training Systems Support (FTSS) contract.

This report documents performance data relative to Contractor training equipment maintenance, repair, and utilization during a specified performance period. The main body of each report shall be completed in accordance with (IAW) the attached sample format.

Block 16 of each Contract Data Requirements List (CDRL) shall tailor each report’s requirements by applying CDRL annex paragraphs 2.1, 2.2, 2.3, and 2.4 (Parts I-IV), with attached sample formats, as applicable. Entry of actual data is to be made in the appropriate column for the period covered by the report.

1.2.2 Format. The report shall contain up to four (4) parts as specified in the contract/task order.

The summary portion Part II, Part III, Part IV, and Part V shall be presented in columnar format to facilitate reporting of data on multi-station devices/equipment items or where multiple devices/equipment items are collocated (refer to applicable samples). Any of the following formats may apply as per blocks 14 and 16 of the CDRL.

1.2.2.1 Hard Copy. Where applicable, individual areas shall be prepared as delineated in the contract/task order on 8.5 X 11 inch size paper.

1.2.2.2 Magnetic Media. Where applicable, individual area files shall be placed on Compact

Disc Recordable/Re-Writable (CD-R/CD-RW) optical disc. File formats shall be compatible with Microsoft Office® as specified in block 16 of the CDRL.

1.2.2.3 Electronic Mail (e-mail). Reports shall be attached files to internet e-mail in Microsoft

Office® compatible formats as specified in block 16 of the CDRL.

2.0 Report Content. The Contractor Device/Equipment Performance Report shall consist of the following areas:

2.1 Part I – Performance Report Summary. The main body of the report shall contain information on the distribution, work accomplished, manning, and problem areas encountered. Data elements not applicable to a specific device/equipment item shall be marked “NA” for alphanumeric fields and “0” (zero) for numeric fields. Data elements to be addressed are as follows in the order shown. (See Figure 1 for a sample Performance

Report Summary).

a) To. Addressees shall be IAW the contract/task order.

b) From. Enter name of the Contractor providing services.

c) Title. Data shall be titled the same as the data item description.

d) Platform - Device/Equipment nomenclature. Identify by nomenclature the trainer(s) which is/are the subject of the report (e.g. KC-130J OFT, FA18E/F TOFT).

e) Device/Equipment Designation – Serial No. (SERNO). Identify alphanumeric training device/equipment Cognizant (COG) 2”O” designation assigned to the device/equipment and associated SERNO (e.g. 2F132-002). If no device number, enter ‘NONE’.

f) Contract Number and Task Order Number.

g) Contract Support Period. Enter start and completion dates of the contract.

(DDMMMYY)

h) Date of Report. Enter the date that the report is completed. (DDMMMYY)

i) Report Period. Enter the ending date of the period covered by the report.

(DDMMMYY). When data is reported on a quarterly basis, use the last month in the quarter.

j) Activity Serviced/Device/Equipment Location. Enter the activity/command assigned as the device/equipment custodian, site, and building(s) where device(s) located.

k) Casualty Report (CASREP). Identify whether a CASREP was initiated during the reporting period.

l) Personal Time Distribution. The time distribution (hours in tenths) of all Contractor personnel for the report period covered shall be classified in the following categories:

(1) Operation - The contractor should record the number of hours actually expended by personnel performing the Continuously Staffed Operations requirement of the SOW/PWS. This category should not be interpreted to mean the hours that the devices are in operation.

(2) Scheduled Maintenance - The Contractor should record the number of hours actually expended to complete the Scheduled Maintenance for each of the devices. The goal of this metric is to capture the actual time to complete the scheduled maintenance, and not the number of hours identified on the MRC.

This also means that if the Technician is performing multiple MRCs simultaneously (i.e., in waiting for a routine or process to run on one device, the technician may also be performing an operation on a different device), they need to attribute their actual hours to each of the devices they are working on.

(3) Unscheduled Maintenance - The Contractor should record the number of hours actually expended to complete the Unscheduled Maintenance for each of the devices. Unscheduled Maintenance consists of O-level and I-

Level work as well as any D-Level work performed on-site by the COMS workforce. If, during the performance of Scheduled Maintenance, a failed component is identified, any actions taken to repair/replace the failed component should be recorded as Unscheduled Maintenance.

(4) Cybersecurity - The Contractor should record the number of hours actually expended to complete all cybersecurity requirements NOT identified on an

MRC card.

(5) Supply Support - The Contractor should record the number of hours actually expended by any person (these hours are not limited to just the

Supply Technician) in performance of any inventory ordering, receiving, and tracking efforts. This may also include parts identification, cross-referencing, and any other efforts typically performed by the Supply

Technician labor classification.

(6) Modification - The Contractor should record the number of hours actually expended by the COMS workforce in assisting a modification contractor in performance of a device modification. This will also include hours expended by the COMS workforce in completion of any Government directed minor modification.

(7) Training - The contractor should record the number of hours actually expended by the COMS workforce in conducting training evolutions. This should include all Government and Contractor required training as well as

On-the-Job Training (OJT) or over-the-shoulder training of COMS personnel.

(8) Verification of Documentation - The contractor should record the number of hours actually expended by the COMS workforce in performance of the

Technical Data Verification CLIN.

(9) Other - The contractor should record the number of hours actually expended by the COMS workforce in performance of other requirements not captured in the above categories. This may be hours spent in meetings with

Government personnel, hours spent performing shift turnover, Access

Control hours, Janitorial hours, etc. If hours are recorded in this category, the “Summary of Work Accomplished” block (“Block 14”) should include a statement identifying what the “Other” hours were expended on.

m) Trainer Downtime. The number of hours the trainer/Equipment was down and not available for scheduled training rounded to the nearest tenth of an hour. Downtime hours shall be classified as follows and the sum of all such categorizations should equal Total Trainer Downtime for the reporting period:

(1) Maintenance

(2) Device Modifications

(3) Parts/Supply Problems

(4) Facilities Problems

(5) Lack of Instructors/Operators

(6) Lack of Set-up Time

(7) Miscellaneous Other

n) Summary of Work Accomplished. Include, at the end of the report, a narrative summary containing the following:

(1) Operation, Maintenance, Supply Support, Mobilization/Transition period status. Provide a brief summary of major work items accomplished and the status, citing any problem areas encountered.

(2) Modification. Describe all changes made to the device configuration.

(3) Training. Describe the nature and extent of training provided by the

Contractor to its on-site personnel. Mobilization training status shall be addressed during mobilization period.

(4) Premium Time (PT) Utilization. List the amount of PT (also referred to as

Additional Time) associated with each funding agent by site for the reporting period and the total cumulative amount of PT provided for each funding agent by site for that fiscal year (FY). Specify PT applicable

C/SLIN (each PT C/SLIN shall have its own separate tab, typically by funding agent), PT used during the reporting period, cumulative PT utilized to date, unit price, funds expended that reporting period, cumulative PT to date, PT funding to date, funding balance, percent of funds remaining, and the hours of simulator training time provided. (See Figure 2 for a sample

Premium Time Utilization Report).

(5) Technical Data Verification (TDV) Utilization. List the amount of documentation associated with each funding agent by site for the reporting period and the total cumulative amount of verification (pages) for each funding agent by site for that FY. Specify TDV applicable C/SLIN, TDV used during the reporting period, cumulative TDV utilized to date, unit price, funds expended that reporting period, cumulative TDV to date, TDV funding to date, funding balance, and percentage (%) of funds remaining.

(See Figure 2 for a sample Technical Data Verification Report).

o) Signature of Contractor Site Manager and Contracting Officer’s Representative

(COR). The report shall be signed by the Site Manager and by the COR or the

Alternate COR (ACOR) in the absence of the COR.

p) Classification of Report. All contract reports and subject contents shall be unclassified (UNCLAS).

q) Contractor Personnel. List all currently employed on-site contractor personnel by name and Department of Labor (DoL) category associated with this contract (e.g., Electronics Technician, Maintenance III). Indicate if full time (“F”) or part time

(“P”). Describe position assignment and/or nature and date of any change in employment status of contractor personnel. Identify Government accepted qualification specialties (i.e., site manager, shift supervisor, V tech, H tech), any special qualifications/training that is required and date qualified (DDMMMYY).

Indicate DoL Anniversary date. (Refer to Figure 4 for sample Contractor Personnel

Report).

EXAMPLE: H. Smith (Full-Time); DOL Code 23183/Electronics Technician, Maintenance III/”Visual” Tech/”Laser Optics” Tech; hired as Tech II 01/01/10 and promoted to Tech III 11/01/11; ANSI Z136.1 Class IIIB qualified Laser

Safety Officer (LSO) 11/01/10. DOL Anniversary Date: 09/11

2.2 Part II - Trainer/Equipment Performance Summary. (See Figure 5 for sample Trainer

Performance Summary Report). The following data elements shall be included:

a) Report Period. Enter the ending of the period covered by the report using YYYYMM numerical format. When data is reported quarterly, use the last month in the quarter.

b) Activity Serviced/Device Location. The activity and location of the device custodian.

c) Device/Equipment Designation – Serial No. (SERNO). Identify alphanumeric training device/equipment COG 2”O” designation assigned to the device/equipment and associated SERNO (e.g. 2F132-002). If no device number, enter ‘NONE’.

d) Trainee station. Indicate the trainee station number for multi-station devices/equipment or device/equipment serial number where multiple devices are co-located.

e) Contracted Training Time (CTT). The total time for the reporting period that the training device is contracted to be available for training. It is determined by adding the daily CTT hours as specified in the contract for all days of the reporting period plus premium time and/or make up training time.

f) Contracted Training Time Utilized (CTTU). The “actual” portion of contracted training time when training occurs.

g) Scheduled Training Time (STT). The total training hours scheduled by the scheduling authority for the reporting period.

h) Non-Chargeable Downtime (NCDT). That portion of total downtime for which the contractor is not held responsible.

i) Chargeable Downtime (CDT). That portion of total downtime attributable to the failure of the Contractor to provide system(s) capable of being used for its scheduled purpose such that the scheduled usage was either postponed, canceled, or materially degraded. The sum of Non-Chargeable Downtime and Contractor Downtime must equal Total Trainer Downtime.

j) Partial Mission Capability (PMC). That portion of CTT during which the device was used in a degraded status. The product of Partial Mission Capability Factor

(PMCF) multiplied by Partial Mission Capability Time (PMCT).

k) Hours Lost Because of No-shows. Enter the training time hours lost during the reporting period due to student no-shows. When an alternate event (i.e., a replacement event) is conducted during this period, do not count as lost hours.

l) Hours Lost Because of Cancellations. Enter the number of scheduled training time hours lost during the reporting period due to cancellations. When an alternate event

(i.e., a replacement event) is conducted during this period, do not count as lost hours.

m) Number of Restarts/Reboots. Number of incidences training is interrupted due to computer (host or subsystem) re-starts/reboots (example: 0/5). Restarts (resets) involve a simple reset of the device back to original mission conditions at the

Instructor Operating Station (IOS) whereas a reboot requires computer system/subsystem re-initialization of the software.

n) Set-up/Initialization Time. Enter the total number of hours used for device set-up or initialization during the reporting period.

o) Utilization of Availability (UA). The quotient expressed by dividing CTTU by

Operationally Ready (OR) Time (CTT less Total Trainer Down Time). The quotient shall be expressed as a percentage to the nearest tenth of a percent.

p) Cumulative Contracted Training Time (CCTT). Cumulative sum of all CTT for the

LOT.

q) Cumulative Contracted Training Time Utilized (CCTTU). Cumulative sum of all

CTTU for the LOT.

r) Cumulative Utilization of Availability. The quotient expressed by dividing the

CCTTU by the cumulative OR. The quotient shall be expressed as a percentage to the nearest tenth of a percent.

s) Contractor Performance Factor (CPF). A percentage calculated IAW with the CPF formula expressed as a percentage to the nearest tenth of a percent.

t) Cumulative CPF. A percentage calculated IAW the CPF formula specified in the contract utilizing the cumulative (LOT) individual values of the elements of the formula’s numerator and denominator expressed as a percentage to the nearest tenth of a percent.

u) Cumulative set-up/initialization time. Cumulative sum of all hours used for device set-up/initialization for the LOT.

v) Cumulative Restart and Reboots. Cumulative (LOT) sum of all NSC.

2.3 Part III – Contractor Maintenance Services (CMS)/Contractor Measurement Factor (CMF)

Hardware Equipment Group Performance Summary. (See Figure 6 for a sample

CMS/CMF Hardware Equipment Group Performance Summary). The following data elements shall be included:

a) Contract No./Task number.

b) Equipment Group. A grouping of hardware equipment under CMS whose aggregate average monthly contractor measurement factor (AMCMF) is associated with an individual CLIN.

c) Contract Support Period. Start and ending date of the period covered by the report using a YYYYMM numerical format. When data is reported on a quarterly basis, use the last month in the quarter.

d) Hardware Nomenclature. Alpha-numeric manufacturer’s name of the hardware.

e) Model Number.

f) Serial Number (SERNO).

g) Hours to Repair. Time lapse from when the Government notifies the Contractor of the requirement for repair or maintenance action to the time the hardware item is delivered to the Government in operational condition (may only apply to specified

Maintenance Support Hours)

h) Contractor Measurement Factor (CMF). The tangible measure of Contractor success in meeting Government operational requirements of hardware. CMF is computed

IAW the contract.

i) Total. The total of hardware CMF for the reporting period.

j) Average Monthly Contractor Measurement Factor (AMCMF). The tangible measure of Contractor success in meeting Government operational requirements for an equipment group. AMCMF is computed in accordance with the contract. (Note: A grouping of hardware equipment under CMS whose aggregate AMCMF is associated with an individual contract line item.

2.4 Part IV – Trainer Support Effectiveness Report. The report shall contain information on the distribution of maintenance actions relative to each device/equipment item and the status of inventory shortages for each device. Data elements not applicable to a specific device/equipment item shall be marked “NA” for alphanumeric fields and “0” (zero) for numeric fields. Data elements to be addressed are as follows, in the order shown. (See

Figure 7 for a sample Trainer Effectiveness Report).

a) Contract/Task Order number.

b) Site Location/Command. Command/Activity location and name.

c) Report Period. Start and ending date of the period covered by the report

(DDMMMYY).

d) Site Location/Command. Command/Activity location and name.

e) Maintenance Action Data. For each device (by SERNO) provide the number of maintenance actions completed during the reporting period that apply to the length categories for “O” Level, “I” Level, and “D” Level actions per Figure 7.

f) Outstanding/Open Maintenance Actions. (Refer to Figure 7):

(1) Device/Equipment Number

(2) MAF number

(3) Date Initiated

(4) Site/Location

(5) Parts name and number ordered or out for repair

(6) Expected date for completion

(7) Level of Maintenance (“O”, “I”, or “D”)

(8) Remarks

g) Inventory Shortages/Missing Items List. Indicate any inventory item shortages.

(Refer to Figure 7):

(1) Device/Equipment Designation – SERNO. Identify alphanumeric training device/equipment COG 2”O” designation assigned to the device/ equipment and associated SERNO (e.g. 2F132-002). If no device number, enter

‘NONE’.

(2) Item name.

(3) Manufacturer’s Part Number.

(4) NSN. (If available)

(5) MAF Number. Maintenance action documentation tracking number associated with the item.

(6) GFP Quantity. Baseline quantity of item in GFP Inventory.

(7) Number of Item Missing. Quantity of item short/missing from Baseline

GFP Inventory.

(8) Unit Cost. (US $$) This is the cost for a single item.

(9) Date Item Ordered. (DDMMMYY)

(10) Date Item Expected. Expected time of arrival (ETS) of item (DDMMMYY)

(11) Comments.

h) Inventory Usage. Indicate any inventory usage items. (Refer to Figure 7).

Specify in columnar format with items reportable as follows: Repair of Repairable

(RoR), high-cost consumables, long lead time items, obsolete, and high-risk parts.

Other items and consumables can be included at the discretion of the COR.

(1) Device/Equipment Designation – Serial No. (SERNO). Identify alphanumeric training device/equipment COG 2”O” designation assigned to the device/equipment and associated SERNO (e.g. 2F132-002). If no device number, enter ‘NONE’.

(2) Item name.

(3) Manufacturer’s Part Number.

(4) NSN. (If available)

(5) Maintenance Action Number. Maintenance action documentation tracking number associated with the item.

(6) Brief failure description.

(7) Frequency of Repair (Reporting period/Cumulative). This data shall be represented for the month reported and as a cumulative number from device Contract Support Date (CSD)

(8) Government Furnished Property (GFP) Inventory Quantity. Total number quantity of items required to be returned to the Government.

(9) Unit Repair/Replacement Cost per Item. (USD $$)

(10) Date Item Ordered or Sent for Repair. (DDMMMYY)

(11) Date Item Expected. Expected time of arrival (ETA) of item (DDMMMYY)

(12) Date Ready for Use. (DDMMMYY)

(13) Comments.

i) Signatures and Dates. The Contractor Site Manager’s and COR’s signatures and signing date shall be entered on each report where specified.

2.5 Part V - Cybersecurity Performance Summary. (See Figure 8 for sample Cybersecurity

Performance Summary Report). The following data elements shall be included:

a) SM Signature.

b) COR Signature.

c) COR Remarks.

d) Contract No./Task number.

e) Site.

f) Equipment Group. A grouping of hardware equipment under CMS whose aggregate average monthly contractor measurement factor (AMCMF) is associated with an individual CLIN.

g) Contract Support Period. Start and ending date of the period covered by the report using a YYYYMM numerical format. When data is reported on a quarterly basis, use the last month in the quarter.

h) Device/Equip #.

i) Cybsersecurity Tasks. Add a column for all required cybersecurity tasks.

j) MONTHLY TOTAL. Provide the monthly total for each category.

k) CUMULATIVE TOTAL. Provide the cumulative total for the current Fiscal Year in each category.

l) ADDITIONAL COMMENTS: Provide details of important cybersecurity tasks and events (i.e. – annual continuous monitoring review, patch install success/failure with assessment, etc.).

2.7 Part VI – Cybersecurity Workforce (CSWF) Report. (See Attachment 1 for sample CSWF

Report). The following data elements shall be included:

a) Contract No./Task number.

b) Site/CMD.

c) Contract Support Period. Start and ending date of the period covered by the report using a YYYYMM numerical format. When data is reported on a quarterly basis, use the last month in the quarter.

d) DOL Category/Tech Qualifications Filled. List all personnel that are required

Privileged User/System Administrator Account Access by Category/Position.

e) Contractor Employee Name.

f) Status. Full or Part Time.

g) Nature and Date of Any Change in Employment, Training, Status or Assignment. Enter in MM/DD/YYYY numerical format.

h) Key Personnel. All employees identified as a System Administrator per Addendum A

4.8.1.c. are considered Key Personnel.

i) Proficiency Level Assigned. See DoD 8570.01M and PWS for Information Assurance

Technical Level Requirements.

j) Signed Privileged Access Agreement (PAA). PAA must be signed prior to initial access, validated annually, and revoked upon transfer or removal from the Cyber

IT/CSWF. Date signed in MM/DD/YYYY numerical format.

k) Signed System Authorization Access Request (SAAR)-N. All Authorized, Enhanced, and Core User of DON Information System must have a current, signed user access agreement. Date signed in MM/DD/YYYY numerical format.

l) Security Clearance. All Authorized, Enhanced, and Core User of DON Information

System must have and maintain the appropriate security clearance. Date signed in

MM/DD/YYYY numerical format.

m) CSWF Nomination Letter. All members of the CSWF must have signed CSWF

Nomination Letter on file. Date signed in MM/DD/YYYY numerical format.

n) Certifications and Expiration Dates. List all certifications with the certification expiration date in MM/DD/YYYY numerical format. Reference Addendum A COMS and Site Specific Appendix for certification requirements.

o) Continuous Learning: All members of the CSWF are required to complete 40 Hours of

Continuous Learning per year and have it documented.

p) Minimum Credential: Education (Approved College Degree) or Approved

Professional/Formal Military Training/Course or Industry Training (approved Formal

Industry Training/Course (80 hours or more within last 36 months) or DoD Approved

Baseline Certification. Reference DoD 8570.01M and PWS for Information Assurance

Technical Level Requirements.

q) OS/CE Certificate of Training: Completed via SkillSoft CBT, FEDVTE, Internet-based

CBT, self-study course, off-base training facility, or on-base training facility/course/school, etc.).

r) Annual Cyber Assurance: Provide in MM/DD/YYYY numerical format.

s) COR Comments:

2.6 Part VII – Uninterruptable Power Supply (UPS) Battery Replacement Report. (See Figure

10 for sample UPS Battery Replacement Report). The following data elements shall be included:

a) Device # - Device number(s) for which the UPS provides support.

b) UPS Mfr. – Manufacturer of the UPS.

c) UPS Model # - Model Number of the UPS.

d) Battery Mfr. – Manufacturer of the Battery installed in the UPS.

e) Battery P/N – Part Number for the Battery installed in the UPS.

f) Last Repl. Date – The date when the Battery was placed into service.

Part I: Performance Report Summary (PRS):

To: (Addressees / Email) 1. Platform - Device / Equipment

Nomenclature:

2 Device/Equipment Cognizant (COG) 2’O’ Designation –

Serial No. (SERNO)

3. Contract No./Task Order No.

4. Contract Support Period

Start (DDMMMYY)

Contract Support Period

End (DDMMMYY)

From: (Contractor / Address) 5. Date of Report (DDMMMYY): 6. Report Period Covered (MMMYY):

7. Activity / Command Serviced: 8. Activity Location: (Base / Bldg(s))

Report Title:

10. CASREP this period? Yes No

11. PERSONNEL DISTRIBUTION HRS 12. TRAINER DOWN TIME HRS

Operation Maintenance

Scheduled Maintenance Device Modification

Unscheduled Maintenance Parts / Supply Problems

Supply Support Facilities Problems

Modifications Lack of Instructor / Operator

Training Lack of set-up time

Verification of Documentation Miscellaneous

Other

Totals Totals

13. SUMMARY OF WORK ACCOMPLISHED (hrs)

Operation, Maintenance, Supply Support Training

Mobilization/Transition Status Premium Time Status/Utilization

Modification TDV Status/Utilization

14. Site Manager: 15. Contracting Officer’s Representative (COR):

Signature / Date Signature / Date

17. CLASSIFICATION OF REPORT: 18. REMARKS:

Figure1. Sample Performance Report Summary

PREMIUM TIME (PT) UTILIZATION REPORT

Signature Site Manager: Date:

Signature COR: Date:

Contract/Task Order#: Report Period:

Site/Command: PT CLIN Number (#)

Month - Year

COL 1 COL 2 COL 3 COL 4 COL 5 COL 6 COL 7 COL 8

Used This Period (hrs)

Cumulative PT/BV hrs Used for

LOT__/FY__

= (hrs)

PT CLIN

Unit Price ($/hr)

PT Funds Expended

(Col 2 * Col 3)

PT CLIN

Funded Amount

PT Funding Balance

(Col 5 – Col 4)

Percent of PT Funds

Remaining (Col 6 / Col 5)

Simulator Training Hours

Provided (hrs)

Total PT Hours Funded: Total Simulator Training Hours Provided:

Hours Remaining:

Remarks:

Figure 2. Sample Performance Summary Report (Premium Time Utilization Report)

TECHNICAL DATA VERIFICATION (TDV) REPORT:

Signature COR: Date:

COR Remarks:

Contract Task Order #: Report Period:

Site/Command:

TDV

CLIN /

SLIN

TDV

Pages

Tasked

This

Period (#)

Cumulative

TDV Pages

Completed

LOT__/FY__

TDV

CLIN

Unit

Price

($/page)

LOT TDV

FUNDS

Expended

LOT

TDV

CLIN

Funded

Amount

LOT TDV

Funding

Balance

Percent of

TDV

Funds

Remaining

Totals:

Figure 3. Sample Performance Report Summary [Technical Data Verification (TDV) Report]

CONTRACTOR PERSONNEL

Signature COR: Date:

COR Remarks:

Contract/Task Order #: Report Period

Site/Command:

DOL WD Category /

Technical

Qualifications

Completed

Contract /

Employee

Name

Employee

Status

Full (F) /

Part (P)

Time

Nature and date of any change in training status or assignment e.g. DOL Code

23183/ Electronics

Tech, Maintenance

III; V (Visual) &

LO (Laser Optics)

Tech

H. Smith (F) H. Smith (Full-Time); Electronics Tech

III/”Visual” Tech/”Laser Optics” Tech; hired as Tech II 01/01/99 and promoted to Tech III

11/01/99; ANSI Z136.1 Class IIIB qualified

Laser Safety Officer (LSO) 11/01/99. DOL

Anniversary Date: 09/99 e.g. DOL Code

23181/Electronics

Tech, Maintenance

I; CL

R. Jones (P) R. Jones (Part Time); Electronics Tech I;

hired as Tech I on 03/26/2016; qualified as

CL on 04/23/2016.

Figure 4. Sample Performance Summary Report (Contractor Personnel)

TRAINER PERFORMANCE SUMMARY REPORT:

Signature COR: Date:

COR Remarks:

Contract/Task Order #:

Device/Equipment

Description:

Site Location/CMD:

Report

Period:

1 Contracted Training Time (CTT) (hrs)

2 CTT Utilized (CTTU) (hrs)

3 Scheduled Training Time (STT) (hrs)

4 Non-chargeable Down-time (NCDT) (hrs)

5 Chargeable Down-time (CDT) (hrs)

6 Partial Mission Capable (PMC) (hrs)

7 Hours Lost to No-shows (hrs)

8 Hours Lost to Cancellations (hrs)

9 Number of Restarts/Reboots

10 Set-up / Initialization Time (hrs)

11 Utilization of Available (UA) CTT (%)

12 Cumulative CTT (hrs)

13 Cumulative CTTU (hrs)

14 Cumulative Utilization of Availability (%)

15 Contractor Performance Factor (CPF) (%)

16 Cumulative CPF (%)

17 Cumulative set-up / initialization time (hrs)

18 Cumulative Number of Restart/Reboots (#)

Note(s): Cumulative values shall be for the exercised LOT and reset at the beginning of each new LOT

Figure 5. Sample Trainer Performance Summary Report

CMS/CMF HARDWARE EQUIPMENT GROUP PERFORMANCE SUMMARY

Signature Site Manager Date:

Signature COR Date:

COR Remark

Contract/Task Order No.

Equipment Group

Site/Command Report Period

HARDWARE EQUIPMENT NOMENCLATURE MODEL No. SERNO

HOURS TO

REPAIR

CMF

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

TOTAL

AMCF

Figure 6. Sample CMS/CMF Hardware Equipment Group Performance Summary

TRAINER SUPPORT EFFECTIVENESS REPORT

Signature COR: Date:

COR Remarks

Contract/Task Order No.

Site Location/Command:

Report Period

Maintenance Action(s) Organizational ‘O’ Level Intermediate ‘I’ Level Depot ‘D’ Level

Days to complete <2 2-

6-

=>11 <10 10-15

15-

=>31 <20 20-30

30-

=>61

Device / SERNO

Outstanding/Open Maintenance Action(s)

Device/Equip No.

MAF

No.

Date

Initiated Site/Location

Part Name

+ No. on order/out for repair

Expected

Completion

Date

Level of Maintenance Remarks

Inventory Shortage(s)/Missing Item(s) List

Device /

Equip No &

SERNO

Item Name

Manuf

Part

No.

NSN

MAF

No.

GFP

Qty

No.

Item(s)

Missing

Unit

Cost

Date

Ordered

Date of

Expected

Return

Comments

Inventory Usage

Device /

Equip

No

Item

Name

Manuf

Part

No.

NSN

MAF

No.

Failure

Descrip.

Freq of

Repair

- Rpt

Perd &

Cmltv

GFP

Qty

Repair

Replace

Cost

Date

Ordered /

Sent for

Repair

Date of

Expected

Return

Date

Ready for

Use

Comments

Additional Comments:

Figure 7. Sample Trainer Support Effectiveness Report

Copy of CDRL A004

PART VI - CYBER WORKFORCE SUMMARY REPORT_ATT 1.xlsx

Figure 8. Sample Cybersecurity Workforce Summary Report

UPS Battery Replacement Report Signature Site Manager

Signature COR Date:

COR Remarks Date:

Contract/Task Order

No.

Site/Command

Device # Report Period

UPS Mfr. UPS Model # Battery Mfr. Battery P/N Last Repl. Date

Figure 9 – UPS Battery Replacement Report