Exhibits_A-E_4Dec26.pdf

UNCLASSIFIED/CUI

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) OMB No. 0704-0188

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 thus burden estimate or any other aspect of this collection o f 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 of 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. B. EXHIBIT C. CATEGORY:

0007/1007/2007/3007/4007 A/B/C/D/E TDP TM OTHER MGMT

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

TH-1H HELICOPTER FD20602600030 EXECUTIVE

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

GROUP

A/B/C/D/E 001 COMMERCIAL ASSET VISIBILITY (CAV)

REPORTING

CAV AF

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

TOTAL PRICE

DI-MGMT-81838 PWS Para 4.6 411 SCMS/GULB

7. DD 250 REQ 9. DIST

STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT SEE BLOCK 16 SEE BLOCK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRA

FT

FINAL

N/A A SEE BLOCK 16 SEE BLOCK 16 Reg Repr o

16. REMARKS

CLIN Exhibit Data Item No. Performance Period A A001 Basic Year Pd B B001 Ordering/Option Period 1 C C001 Ordering/Option Period 2 D D001 Ordering/Option Period 3 E E001 Ordering/Option Period 4

EMAIL:

411 SCMS/GULBA

PROGRAM

MANAGER

DANIELLE

CROSBY,

DANIELLE.CROSB

Y@US.AF.MIL

0 1

The contractor shall report End Item transactional data through electronic submission in CAV AF using the CAV AF web site or CICA XML IAW the referenced DID IAW and/or CAV AF CFM Reporting Requirements. This information will be accessed by the program office SP and by 420 SCMS/GUNAB-Robins in order to ascertain production status.

Transactions and data will be submitted by the contractor daily IAW CAV AF User Guide, Version 8.0.1 or higher.

The Contractor shall obtain a valid DOD PKI certificate to log into CAV AF. Each user shall be required to have an Identity Certificate only; an encryption certificate is not required.

Training will be provided by 420 SCMS/GUNAB-Robins, (478) 327-6603 or 6602 if required and a request must be initiated by the CAV Reporter

This DD Form 1423-1 applies to Contractor Furnished Materiel (CFM) type contracts.

BLK 10:

a. Contractor reporting requirements to CAV AF shall be accomplished daily and/or within 24 hours of a supply or maintenance action occurrence IAW Contractor Users Guide.

b. The method of communication from the contractor to the funding base will be mechanized using the CAV AF Online web site IAW CAV AF Contractor Users Guide.

BLK 11: Data shall be current within 24 hours of last End Item maintenance occurrence.

BLK 12: Date of first submission shall be within 24 hours following a supply or maintenance transaction after the contract award date and government training as specified in IAW CAV AF Users Guide.

BLK 13: Same as remarks regarding Block 10 above.

EMAIL:

411 SCMS/GULBB

SUPPLY PLANNER

SHARON.QUINN@

US.AF.MIL

0 1 0

15. Total 0 2 0

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

DD FORM 1423, Feb 2024 UNCLASSIFIED/CUI Page 1 of 7 Pages

12/03/2025 12/04/2025

(1 Data Item) OMB No. 0704-0188

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 thus burden estimate or any other aspect of this collection o f 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 of 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. B. EXHIBIT C. CATEGORY:

0007/1007/2007/3007/4007 A/B/C/D/E TDP TM OTHER MGMT

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

TH-1H HELICOPTER FD20602600030 EXECUTIVE

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

GROUP

A/B/C/D/E 002 Government Property (GP) Inventory Report Government Property Inventory Report

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

TOTAL PRICE

DI-MGMT-80441D PWS Para 3.4 411 SCMS/GULB

7. DD 250 REQ 9. DIST

STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT ANNUALLY SEE BLK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRA

FT

FINAL

A A SEE BLK 16 SEE BLK 16 Reg Repr o

16. REMARKS

CLIN Exhibit Data Item No. Performance Period A A002 Basic Year Pd B B002 Ordering/Option Period 1 C C002 Ordering/Option Period 2 D D002 Ordering/Option Period 3 E E002 Ordering/Option Period 4

EMAIL:

411 SCMS/GULBA

PROGRAM

MANAGER

DANIELLE

CROSBY,

DANIELLE.CROSB

Y@US.AF.MIL

0 1 0

BLK 4: The data item description (DID) contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract. See Data Item Description at http://quicksearch.dla.mil/ for content requirements and most current version.

Block 8: Approval (written) is not required. However, the data item will be reviewed and accepted/rejected, based on its conforming to the requirements of the DID, and within the review time specified in Block 16, items 10-13.

BLK 9: "A" Approved for Public Release; distribution is unlimited.

Block 10-13: The annual physical inventory report shall be provided within seven

(7) calendar days of the end of each option/ordering period for the contract. The data is representative of the Contractor's Internal Property Control System and shall be current as of the last day of the option/ordering reporting period. If requested outside of an annual cadence, the data shall be current as of the date requested.

BLK 14: EMAIL electronic Annual Physical Inventory Report to the Supply Planner (SP) Sharon Quinn, sharon.quinn.@us.af.mil and Program Manager (PM) Danielle Crosby, danielle.crosby@us.af.mil. Submit digital copy in Microsoft Office Excel format for all reports.

EMAIL:

411 SCMS/GULBB

SUPPLY PLANNER

SHARON QUINN

SHARON.QUINN@

US.AF.MIL

0 1

15. Total 0 2 0

DD FORM 1423, Feb 2024 UNCLASSIFIED/CUI Page 2 of 7 Pages

(1 Data Item) OMB No. 0704-0188

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 thus burden estimate or any other aspect of this collection o f 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 of 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. B. EXHIBIT C. CATEGORY:

0007/1007/2007/3007/4007 A/B/C/D/E TDP TM OTHER MGMT

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

TH-1H HELICOPTER FD20602600030 EXECUTIVE

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

GROUP

A/B/C/D/E 003 Contract Depot Maintenance (CDM) Monthly Production Report

Production Report

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

TOTAL PRICE

DI-PSSS-81995A PWS Para 4.3.7 411 SCMS/GULB

7. DD 250 REQ 9. DIST

STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT SEE BLOCK 16 SEE BLOCK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRA

FT

FINAL

SEE BLOCK 16 A SEE BLOCK 16 SEE BLOCK 16 Reg Repr o

16. REMARKS

CLIN Exhibit Data Item No. Performance Period A A003 Basic Year Pd B B003 Ordering/Option Period 1 C C003 Ordering/Option Period 2 D D003 Ordering/Option Period 3 E E003 Ordering/Option Period 4

EMAIL:

411 SCMS/GULBA

PROGRAM MANAGER

DANIELLE CROSBY,

DANIELLE.CROSBY@

US.AF.MIL

0 1

1. Block 4:

a. All reporting shall be submitted in the English Language.

b. The Contractor's CAV AF Reporting shall reflect their inventory property control management system data records which shall represent timely and accurate accountability of AF inventory assets at the physical location(s) of the contractor's repair facility (including subcontractor facilities); shop floor, bond room and/or receiving/shipping docks, etc. for each repair.

c. The Contractor shall report by contract delivery order on all applicable categories, totals and on-hand balances, providing TABLE I (DI-PSSS-81995) for EACH repair location, including subcontractor facilities, for the contracts maintenance occurrence actions during the reporting period. d. The Contractor shall report on production, providing TABLE I (DI-PSSS-81995) for EACH repair location, including subcontractor facilities, for which the contractor produced assets during the reporting period.

2. Block 7, 14: Submit the CDM Production Monthly Status Reports to the following email address:

Supply Planner (SP) Sharon Quinn, sharon.quinn.@us.af.mil and Program Manager (PM) Danielle Crosby, danielle.crosby@us.af.mil.

3. Block 9:

a. DISTRIBUTION STATEMENT "D": Distribution authorized to the Department of Defense and U.S.

DoD contractors only (Reason for Use). (Date of Determination). Other requests for this document shall be referred to (DoD Controlling Office)

b. EXPORT CONTROL WARNING: All technical documents/data (printed, digital/electronic) that are determined to contain export-controlled technical data, shall be marked with the following statement:

EXPORT CONTROL WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979 (Title 50, U.S.C., App. 2401 et seq.), as amended. Violations of these export laws are subject to severe criminal penalties. Disseminate IAW provisions of DoD Directive 5230.25. c. DESTRUCTION NOTICE : For classified documents, follow the procedures IAW DoD 5220.22-M, National Industrial Security Program Operating Manual (NISPOM), Section 5-705, and DoDM 5200.01 Vol 3, DoD Information Security Program: Protection of Classified Information, Enclosure 3, paragraph 17. For unclassified, destroy by any method that will prevent disclosure of contents or reconstruction of the document IAW DoDI 5230.24 Enclosure 3 Paragraph 17. 4. Blocks 10, 11, 12, 13: a. The reports shall be provided monthly within 10 (ten) business days of the previous month's last calendar date. b. Reports shall continue to be submitted by the contractor unless the requirement is terminated by the assigned Contracting Officer at the request of the Program Manager (PM) and the Supply Planner (SP), The Final Report submitted following the final reporting period on the contract shall be annotated "Final Report"

EMAIL:

411 SCMS/GULBB

SUPPLY PLANNER

SHARON QUINN

SHARON.QUINN@US.

AF.MIL

0 1

15. Total 0 2 0

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

DD FORM 1423, Feb 2024 UNCLASSIFIED/CUI Page 3 of 7 Pages

12/03/2025 12/04/2025

(1 Data Item) OMB No. 0704-0188

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 thus burden estimate or any other aspect of this collection o f 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 of 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. B. EXHIBIT C. CATEGORY:

0007/1007/2007/3007/4007 A/B/C/D/E TDP TM OTHER MGMT

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

TH-1H HELICOPTER FD20602600030 EXECUTIVE

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

GROUP

A/B/C/D/E 004 Item Unique Identification (IUID) Marking Plan IUID Marking Plan

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

TOTAL PRICE

DI-MGMT-81803A PWS Para 4.4.1 411 SCMS/GULB

7. DD 250 REQ 9. DIST

STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT QUARTERLY SEE BLOCK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRA

FT

FINAL

SEE BLOCK 16 C SEE BLOCK 16 SEE BLOCK 16 Reg Repr o

16. REMARKS

CLIN Exhibit Data Item No. Performance Period A A004 Basic Year Pd B B004 Ordering/Option Period 1 C C004 Ordering/Option Period 2 D D004 Ordering/Option Period 3 E E004 Ordering/Option Period 4

EMAIL:

411 SCMS/GULBA

PROGRAM

MANAGER

DANIELLE

CROSBY

DANIELLE.CROSB

Y@US.AF.MIL

1 1 0

BLK 9: "C" Distribution authorized to U.S. Government Agencies and their contractors (Administrative or Operational Use, 28 April 16) Other requests shall be referred to the contract management team, AFSCC/PZAAA 460 Richard Ray BLvd, Suite 221, Robins AFB, GA 31098

BLKS 10-13: The contractor shall submit a complete IUID Marking Plan within 30 calendar days after contract award. The Government will review and determine acceptance or rejection and notify contractor within 10 calendar days of receipt. If rejected, the contractor shall have 10 calendar days to correct any error and return a corrected IUID Marking Plan to the Government for review.

BLK 7, 14: Forward one electronic copy in PDF format to the following email addresses:

Program Manager: Danielle Crosby (danielle.crosby@us.af.mil) Engineer: Charles Foley (charles.foley.5.ctr@us.af.mil)

EMAIL:

AFSC/PZAAA

CONTRACTING

OFFICER (PCO)

SHAWNA

BARRETT

SHAWNA.BARRET

T@US.AF.MIL

0 1

EMAIL:

DCMA/ACO 0 1 0

EMAIL:

AFLCMC/WIUEE

ENGINEER

CHARLES FOLEY

CHARLES.FOLEY.5

CTR@US.AF.MIL

1 1 0

15. Total 2 4 0

DD FORM 1423, Feb 2024 UNCLASSIFIED/CUI Page 4 of 7 Pages

(1 Data Item) OMB No. 0704-0188

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 thus burden estimate or any other aspect of this collection o f 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 of 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. B. EXHIBIT C. CATEGORY:

0007/1007/2007/3007/4007 A/B/C/D/E TDP TM OTHER MGMT

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

TH-1H HELICOPTER FD20602600030 EXECUTIVE

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

GROUP

A/B/C/D/E 005 Item Unique Identification (IUID) Marking Activity, Validation and Verification Report

IUID Report

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

TOTAL PRICE

DI-MGMT-81804A PWS Para 4.4.2 411 SCMS/GULB

7. DD 250 REQ 9. DIST

STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT QUARTERLY SEE BLOCK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRA

FT

FINAL

SEE BLOCK 16 C SEE BLOCK 16 SEE BLOCK 16 Reg Repr o

16. REMARKS

CLIN Exhibit Data Item No. Performance Period A A005 Basic Year Pd B B005 Ordering/Option Period 1 C C005 Ordering/Option Period 2 D D005 Ordering/Option Period 3 E E005 Ordering/Option Period 4

EMAIL:

411 SCMS/GULBA

PROGRAM

MANAGER

DANIELLE

CROSBY

DANIELLE.CROSB

Y@US.AF.MIL

1 1 0

BLK 4: IUID Marking Activity and Verification Report can be combined with the monthly status report.

BLK 7: Applicable code as listed in DOD 5010.12-M, Chapter 3. (LT for Letter of Transmittal if not separately priced or DD if separately priced) WAWF E-DD FORM 250 shall be required for separately priced data. E-DD FORM 250 shall be submitted to FA8524 (danielle.crosby@us.af.mil) for acceptance.

BLK 8: Approval (written) is not required. However, the data item will be reviewed and accepted/rejected based on its conforming to the requirements of the DID, and within the review time specified in Block 16, items 10-12.

BLK 9: "C" Distribution authorized to U.S. Government Agencies and their contractors (Administrative or Operational Use,28 April 16) Other requests shall be referred to the contract management team, AFSCC/PZAAA 460 Richard Ray BLVD, Suite 221, Robins AFB, GA 31098

BLKS 10-13: Contractor shall submit an IUID Marking Activity and Verification Report to the Engineer AFLCMC/WIUEE, every three months (quarterly). Written Government acceptance/comments/rejection will be within 10 working days after receipt of Plan from the Contractor. Contractor final submission shall be submitted within 10 working days of receiving Government comments. Acceptance by the Government is required prior to formal distribution

BLK 14:Forward one electronic copy in PDF format to the following email address:

Procuring Contract Officer (PCO): Shawna Barrett (shawna.barrett.@us.af.mil) Program Manager (PM): Danielle Crosby (danielle.crosby@us.af.mil) Engineer: Charles Foley (charles.foley.5.ctr@us.af.mil)

EMAIL:

AFLCMC/WIUEE

ENGINEER

CHARLES FOLEY

CHARLES.FOLEY.5

@US.AF.MIL

1 1 0

EMAIL:

AFSC/PZAAA

CONTRACTING

OFFICER (PCO)

SHAWNA

BARRETT

SHAWNA.BARRET

T @US.AF.MIL

0 1 0

EMAIL:

DCMA/ACO

0 1 0

15. Total 2 4 0

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

DD FORM 1423, Feb 2024 UNCLASSIFIED/CUI Page 5 of 7 Pages

12/03/2025 12/04/2025

(1 Data Item) OMB No. 0704-0188

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 thus burden estimate or any other aspect of this collection o f 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 of 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. B. EXHIBIT C. CATEGORY:

0007/1007/2007/3007/4007 A/B/C/D/E TDP TM OTHER MGMT

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

TH-1H HELICOPTER FD20602600030 EXECUTIVE

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

GROUP

A/B/C/D/E 006 Counterfeit Prevention Plan CPP

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

TOTAL PRICE

DI-MISC-81832 PWS Para 4.6.1 411 SCMS/GULB

7. DD 250 REQ 9. DIST

STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT SEE BLOCK 16 SEE BLOCK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRA

FT

FINAL

A C SEE BLOCK 16 SEE BLOCK 16 Reg Repr o

16. REMARKS

CLIN Exhibit Data Item No. Performance Period A A006 Basic Year Pd B B006 Ordering/Option Period 1 C C006 Ordering/Option Period 2 D D006 Ordering/Option Period 3 E E006 Ordering/Option Period 4

411 SCMS/GULBA

PROGRAM

MANAGER

DANIELLE

CROSBY,

DANIELLE.CROSB

Y@US.AF.MIL

1 1

BLK 4: The Data Item Description contains the format and content preparation instructions for the data product generated by the specific and discrete task requirements delineated in the statement of work. See Data Item Description at http://quicksearch.dla.mil/ for content requirements and most current version.

BLK 7: The Government will accept the receiving report through WAWF. The contractor shall submit the receiving report upon final submission to DODAAC FA8524, Attention:

Danielle Crosby, danielle.crosby@us.af.mil (Program Manager) to account for data previously submitted by letters of transmittal. The Government will approve/disapprove within 30 calendar days after receipt.

BLK 9: "B" Distribution authorized to U.S. Government agencies only (Administrative or Operational use) (28 April 16). Other requests shall be referred to the contract management team, AFSC/PZAAA, 460 Richard Ray Blvd, Suite 221, Robins AFB, GA 31098.

BLKS 10-13: Draft Counterfeit Prevention Plan shall be submitted electronically within 30 workdays after contract award. Contractor shall provide quarterly updates as necessary until final at completion of program. The Government will have 15 workdays to approve, submit comments, or disapprove all submissions. The contractor shall have 15 workdays to resubmit report if changes were deemed necessary by the Government.

BLK 14: EMAIL electronic Counterfeit Prevention Plan to the following email address:

Procuring Contract Officer (PCO) Shawna Barrett, (shawna.barrett.@us.af.mil)

AFSC/PZAAA,

Program Manager: Danielle Crosby (danielle.crosby@us.af.mil) Engineer: Charles Foley (Charles.Foley.5.ctr@ us.af.mil)

EMAIL:

AFSC/PZAAA

CONTRACTING

OFFICER (PCO)

SHAWNA

BARRETT

SHAWNA.BARRET

T@US.AF.MIL

0 1

EMAIL:

DCMA/ACO 0 1 0

EMAIL:

AFLCMC/WIUEE

ENGINEER

CHARLES FOLEY

CHARLES.FOLEY.5

.CTR@US.AF.MIL

1 1

15. Total 2 4 0

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

DD FORM 1423, Feb 2024 UNCLASSIFIED/CUI Page 6 of 7 Pages

12/03/2025 12/04/2025

(1 Data Item) OMB No. 0704-0188

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 thus burden estimate or any other aspect of this collection o f 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 of 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. B. EXHIBIT C. CATEGORY:

0007/1007/2007/3007/4007 A/B/C/D/E TDP TM OTHER MGMT

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

TH-1H HELICOPTER FD20602600030 EXECUTIVE

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

GROUP

A/B/C/D/E 007 Accident/ Incident Report Accident/ Incident Report

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

TOTAL PRICE

DI-SAFT-81563 PWS Para 5.5.2 411 SCMS/GULB

7. DD 250 REQ 9. DIST

STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT SEE BLOCK 16 SEE BLK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRA

FT

FINAL

N/A B SEE BLK 16 SEE BLK 16 Reg Repr o

16. REMARKS

CLIN Exhibit Data Item No. Performance Period A A007 Basic Year Pd B B007 Ordering/Option Period 1 C C007 Ordering/Option Period 2 D D007 Ordering/Option Period 3 E E007 Ordering/Option Period 4

EMAIL:

AFLCMC/WIUEE

ENGINEER

CHARLES FOLEY

CHARLES.FOLEY.5

.CTR@US.AF.MIL

0 1

NOTE: Changes to office symbols and/or e-mail addresses, when necessary, shall be made by letter through the Government CO/ACO without further revision to this

CDRL.

BLK 10: IAW AFI 91-204, if damage occurs

BLK 11: Once assets have been received after contract award

BLK 12: 24 hours after accident/incident

BLK 13: As needed, IAW AFI 91-207

Program Manager: Danielle Crosby (danielle.crosby@us.af.mil) Engineer: Charles Foley (charles.foley.5.ctr@us.af.mil)

411 SCMS/GULBA

PROGRAM

MANAGER

DANIELLE

CROSBY,

DANIELLE.CROSB

Y@US.AF.MIL

0 1

EMAIL:

AFSC/PZAAA

CONTRACTING

OFFICER (PCO)

SHAWNA

BARRETT,

SHAWNA.BARRET

T@US.AF.MIL

0 1 0

15. Total 0 3 0

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

DD FORM 1423, Feb 2024 UNCLASSIFIED/CUI Page 7 of 7 Pages

12/03/2025 12/04/2025