Exhibit A Contract Data Requirement List 6 Feb 20.pdf

Exhibit A '['ahle of Contcnts

Contract ID :

Contract No.:

System Item:

Sequence Number

Aircraft -Maintenance Backshop

FA2486- 19-R-0003

Backshop

DID

Title

Page No.

A00l

A002

A003

A004

A005

A006

A008

DI-MISC.80678/T

Certit'ication/Data Report

DI-ENVR-8I375

Environmental Health and Safety Plan (HSP)

DI-MGM'r-80004A/t' Drug Free Work Force

DI-MGMT-81864

Contracting Funds Status Report

DI.MGMT.819I IA

Contingency Strike Plan

DI.MGMT'-8I9I1A

Contingency Plan

DI-MGMT-8I9I IA

Qualitl' Control Plan

DI-MGMT.8O44IB

CAP Reporting

J

.1

A007

CONTRACT DATA REOUIREMENTS LIST

l7 Data ltem) OMB No. O7O4-O18A dara sour..s, g.ihering and m.'n!rin ng ihe dara need.d, and .ompl.tno a.d revie*.9 Send comments regarding ih's burden esnmai. o. anY olher aspecl ol this correct'on ol inlorm.rion, includ'ng sugg€srlo.s ror reducing the burden, 10 the Oepanme.t of Dere.se, Execurive SeNices and Commun'catons Dnecto..le (0704 Olaa). Besrondenrs should be awor€ thar nolwnhstandi.g any orher provson ot law, no perso. shal be sub)ecl to any p€nalry tor la ing to comply wnh a colleclion ol Lnfo.mailon rf tr doas nor dlsp ay a cure.rly valid OMB contol number. Pl.rt. do mt ..tur. your lorm ro th. !bov. orgtnization. S.nd compl.ted fom ro th.

Gov€hm.ni lr.uing Conracring Ofiic.r lor rhe Conira.r/PR No. li.red ln Block E.

A. CONTRACT LINE ITEM NO

All Data CLINS

B. EXHIBIT C, CATEGORY

N,I IS('

TM

D. SYSTEM/ITEM

Aircraft Maintenance - Backshop

E. CONTRACT/PR NO.

FA24U6- 19-R-0001

F CONTRACTOR

A00l

2 TITLE OF DATA ITEM

Certifi cationrData Repon

3 SUSTITIE

Contractor Employee Qualifi cations and Certifications Report

4. Avr{Oefif tData Acouislion Dacunent No )

DI-MISC.8O678/T

5 CONIRACT REFEFENCE

PWS 2.6 Employee Requireulents g6TW/MXri

N1A

I]

See Blk l6

]2 DATE OF FIBST SUAMISSION

See Blk l6

N/A See Blk l6

13 OAT€ OF SUBSEOU€''JT

SUBMISSION

See Blk 16

Blk4: Contractor Fonnat Shall be Acceptable. Delete sections 10.1, 10.2, 10.2.1, 10.2.3, 10.3,10.3.1 and 10.3.2. All other sections use ifapplicable.

Blk 9: Distribution Code B: Distribution authorized to U.S. Govemment Agencies only (Proprietary Infonnation)(25 July 2014). Other requests for this document shall be referred to 96TW/MXG.

Blk 10, ll, l2 & 1l: Proofofthe ernployee's qualifications/cenifications will be provided to the CMO within l5 days ofperfonnance stat, prior to any new hire's employment, or if an employee relocates between shops for CMO final approval.

BIock l4: Report shall be in electronic fbrmat cornpatible with Microsoft Office XP or higher software or unless otherwise directed by the Government with the following file name structure: CDRL A001- "Name". The delivery method is by ernail g6TW/MXG I

AFTCIPZZ I

15, TOTAL _ 0 ) 0

G. PREPARED BY

D,O'l,ally s'qned by

BRAWNER ER|CA 1031320930 ERAWNER ER|C A 1041320930

D6te:2013 12.17 03 42:57 46 00'

H. DATE

t2 7t20t9

I. APPROVED 8Y

1081320s30 B$-jii,:ilti.l",'l:18'.$

J. DATE

t2/17 /20t9

DD FORM 1423-1, FEB 2OO1 Page of age tl

I f--r--r H-

PREVIOUS EDITION MAY BE USED,

(l Data ltem) OMB No. 07O4-O188 daia sources, garh{ing and mainia'n'ns the dala needed, 6nd compler.g and .ev'ewinq ihe .olb.rion ol 'nro,ma!on.

Send commenrs reqa.di.g th s burde. esrimare o, any other aspeci ol ol inform.rion, n.ludino sugqesrons lor .edu.ing rhe burde., ro rhe Dep. ment oI Delense, Erecltlve Serv'ces and Commun'catons D reclorale |O7O4.O188l. Fespondonis should be .ware ihat norwnhsr..d'ng any orher prov's'on ot law, no person shall be subl€cr lo any penaity lor la'lnq lo complv w lh .

co ecion of inrormalion iI il does nor display 6 cunenny vald OMB conrol .umber. Pl..$ do nor rerum your lorh to tho ab.v. o.g..i2arion. S.nd complered lorn ro rh.

Golern@nr l!.uing Conrr.cting Ollic.. for rh. Conir.ctlPB No.lhr.d in 6loct E.

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

EN VR

TM

D. SYSTEM/ITEM

Aircraft Maintenance - Backshop

E. CONTRACT/PR NO.

F'A2486- l9-R-0003

F, CONTRACTOR

A002

2, TITLE OF OA-TA ITEM

Environmental Ilealth and Safety Plan (HSP)

3 SUBTITTE

4. AuIHOefi\ loata Acauisjno. Docunent No )

DI-ENVR-81375

5 CONTAACT REfERENCE

PWS 7. I 96'fWrMXG

N/A

9, DIST SIAIEMENT

B

See Blk l(r

]2 DATE OF FIBST SUEMISSION

See Blk l6

NiA See Blk I6

13 DAT€ OF SUBSEOU€NT

See Blk l6

Blk 4: Contractor fonnat is acceptable

Blk 9: Distribution Code Br Distribution authorized to U.S. (io!ernrnent Agencies only (Proprietary Inforolation)(25 July 201,1). Other rcquests for this docurnent shallbe referred to 96TW/MXG.

Blks l0-ll: The senice provider Safety and Ilealth Plan shall beprovidedtothe CMO al performance start and shall be updated to maintain currency as required.

BIock l4: Report shall be in electronic fomrat compatible with Microsoft Office XP or higher software or unless otherwise directed by the Govemment with the following file name structure: CDRL 4002+ "Narne". The delivery rnethod is by email.

96TW/MXG I

AFTCIPT,Z I

0 0

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

DD FORM 1423-1, FEB 2OO1 PREVIOUS EDITION MAY 8E USED Page Pages

I tl+ r-T f -Ttl

F ttt t-

CONTRACT OATA REOUIREMENTS LIST

(l Data ltem) OMB No. O704-O188 data sources, galhering and ma'nlanng fie d6la needed, and comprel,ng and revewing the co ecton ol .rormarlon Send commenc .egard'ng rhis burden esrmar€ o. any orher 6spe.t of thls collection ol nlormaron, includ'ns sugsesr ons lor reducinq rhe burden, ro the oepa,rment of Defense, Execul've servic€s a.d commlncarons coll€cton o, nformatonifitdo.snoidlsplayacu enny val'd OMB conno number. Please do nor r.turn you, form to rh. above oro.nl28rion. Send complered lom ro rh6 Gov.hm.nr ls3uing Cont.ciing Olli..r lo. th. Contaci/PR No. lirt.d in Bloc* E.

A- CONTRACT LINE IIEM NO B. EXHIEIT C, CATEGORY MISC

OTHER

O. SYSTEM/ITEM

Aircraft Maintenance - Backshop

E. CONTRACT/PR NO.

F A2.186- l9-R-0001

F, CONTRACTOR

A003

2 TITLE OF DATA ITEM

Drug-Free Work Force Program Plan

5. CONTRACT REFERENCE

PWS 2.5 Drug Testing 96TWiMXG

7 00 250 REO

NiA See Blk 16

12, DATE OF FIFSI SUBMISSION

See Blk l6

See Blk I6

I3, OATE OF SUASEOUEI\IT

SUBMISSION

See Blk 16

Blk 4: Contractor fonnat is acceptable. Delete scction 3.2. All other sections use if applicable.

Blk 8: The Govemnrent will provide approral rlithin 30 da.vs ofreceipt

Blk 9: Distribution Code B: Dist bution authorized to U.S. Govemment Agencies only (Proprietary Information)(25 July 2014). Other requests for this document shall be refened to 96TW/MXG.

Blk 10, I l, l2 & l3: The service provider shall develop appropriate personnel procedures as part ofthe program to handle ernployees who are found to be abusing or under the influence ofalcohol or drugs on duty. The service provider shall develop a program in writing, prohibiting employees from using, possessing, being under the influence (drugs or alcohol), or otherwise being involved with illegal drugs and from abusive use ofcontrolled substances. The first subrnission shall be NLT 30 calendar days after contract award. The program shall ensure employees are randonrly tested for substance abuse, in addition, proofthe program is active shall be submitted to the CMO Chiefon a monthlv basis.

Block l4: Repo( shall be in electronic fonnat cornpatible with Microsofi Oftce XP or higher software or unless otherwise directed by the Govemnrent with the following file name structure: CDRL A003 + "Name". The delivery method is by email.

96TWMXG I

AFTCIPZT,

15 TOTAL + 0 0

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

1A ESTIMAIEO

DD FORM 1423-1 , FEB 2OO1 Page ase

4. AUTHOAITY /Dala /.qursnton Oocument No )

DI-MGMT.8OO04A/T

Il llrl

T---r--tl+ T

PREVIOUS EDITION MAY BE USED

ll Data hem) OMB No. 07O4-O188 dats sou.ces, q.$er ng and mainianhg rhe dat. ne.d.d, and completlng and rev ew'ng lhe colecrion or lnrormsllon Send commenrs roga.ding thls bu.den estmaro or any other aspecr o, ths.oll..ton of intomanon, ncludlng suggesto.s lor reduc,ng rhe burden, lo lhe Oepanmenl ol O€lense, Execurive Servces Orectorate lO7O4 OlaA). R.spondenis should be aware rhar norwnhsrand.g any olher prov sion ol law, no person shall be sublecl to a.y penarty lor la'r,ng io compiy with a coll€ci on o, lnlo.matlo. il tr d@s noi d sp av a clrenllv valid o MB cont'or number. Pl..!. do hor.erum your rorh ro rhe.bove orgr.izarion. s.nd comol.red lom to rh.

oov.nm.m l*uing Conr&iing Oflics lor th. Conu.ct/PA No. lisrcd in Bbcr E.

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

OTXER MISC

O. SYSTEM/ITEM

Aircrati Mainlenance - Backshop

E. CONTRACT/PR NO.

I:A21li6-19-tt-0003

F. CONTRACTOR

A00,1

2 IITLE OF DATA ITEM

('ontracting IrunLis Slrtus llcpofl

3 SI]BTITLE

Nlonlhl) Funding Rcport

rt. AUTHORITY /Arr, /4.ou6nion Do.Lnent No )

DI.MGMT.8I864

5, CONTRACT REFEAENCE

NA 96TW MXG

7 0D 250 REO

N/A

9, DIST STATEMENT

B

Scc Blk 16

12 OATE OF FIFST SUAMISSION

See Blk l6

NlA

13, OATE OF SUBSEOUENT

See Blk l6

Blk,l: Contraclor lormat is acceptablc. All other sections usc il'applicable

BIk 8: The Contractor shall producc a ('onlracling Funds Stalus Rcpon (CFSR) monthl) to theCOandCOR. lheCIrSRshall .eporl using DD IrORM l586.rndshall inclLrde all costs related to CI{ Cl,lNs. ( osls $itl be reponcd b} Iine itenr to the lasks thai ucrc underlakcn during the reporling pcriod.

Blk 9: Distribution Code B: Distribution aurhorized to U.S. Go\emment Agencics onl) (Proprietar, lnformation)(25 July 2014). Olher requests for this document shall be refcrrcd to 96TWMXC.

Block l4: Rcporl shall be in electronic Ibrnrrt compatible uith l\4icrosoll OI'fice Xl'or higher soltwarc or unlcss olher\!ise direclcd b) the Covemment \\ilh thc fbllo\\ing lilc namc struclure: Cl)Rl- ,^00,1 + "Narne". I he deliven method is br email.

961W,\4XC I

A1:TC,P77 I

15 rorAl + 0 2 0

G. PREPARED BY

Eric Brau,ner

H. DATE I, APPROVEO BY J, DATE

14, ESTIMATED

PagesDD FORM 1423-1. FEB 2OO1 PREVIOUS EDITION MAY BE USED Page

See Blk l6

I ttt++ ttt tltltl+ ttt tl+ ttt

T---r--l1 Data ttem) OMB No. 0704-O188 data sou.ces, gaih.rng and mainiamng rh6 dat. n.eded, and complen.g and revrcwing rhe cole.rio. of .fomarlon. Send comm€nrs reqardlng ths burden esrimare o, any othe. aspect ol rhs collecrion ol inromaron, nciuding suggesto.s lor reducing the burden, ro rhe Oepanmenr o, Derense, Execltve Servc* Dtr6.tor.re lOTOa 0186). Bespo.denis should b€ aware thar norwnhsland ns any olher prov sion oI law, no pe.sofl shall be sub,ecl lo .nV pena tv tor rarlng io.omp y with . .ollecton ol inlorm.rlon if il d@s nor display a cutrenrry vahd OMB c Pl.at. d. mr reruh your ro'm ro the.bov. or!.niz.r'6a. Send compl.r.d tom ro rhc 6ov..n@d lsrdng Conv*ring Ofiic* lo, rh. ConreUPn No. li{.d in abd E.

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

orHEB MISC

D SYSTEM/ITEM

.\ircrali \'{rrintcnance - Buckshop

E. CONTRACT/PR NO.

I:Al.lli6- I9-R-0001

F. CONTRACTOR

A005

2 N-TLE OF OAIA ITEM

Work Managemenl Plan

3 SUBTITLE

Contingenct Slrike Plan

a. AUTHORITY /Dar, /A.qr,!liah Docuhent No )

DI-MGMT-8I9IIA

5 CONTRACT REFERENCE

PWS 6.3 96TWiMXC

7 DO 250 FEO

NiA

9. OIST STATEMENT

B

See Blk 16

12 DATE OF FIRST SUBMISSION

See Blk l6

DISTRIBUTION

See Blk l6

]3 OATE OF SUBSEOUENT

S sro ee

N

Btk l6

Blk4: Contractor lbrmat is acceplable. lheplanshalldclail hou, the conlracrcr will mitigate labor fbrce strike. hand how lhe contractor $ill cnsure continued pcrlbrmance in the event ofa labor lorce strike.

Illock numbers 7 & 8: Contractor's contingcnc; strike plan \ill be rc\ie\\od and acceptcd or rejected bl thcCo\emmenl\\ilhing30\\orkingdalsalicra*ardofthccontract. lf rcjccted the conlractor shall revise and rcsubmit the documcnl within l0 $orking days al'ter receipt unlcss orhcrwise directed by thc CO. Approval is the responsibiliq oflhe I)OM.

Blk 9: Distribution Code B: Dislribution authorized to tJ.S. Covemment Agencies only ( Proprietary- lnformation )( 25 J ul) 20 I 4 ). Other requests lbr ih is doc ument sha I I be refened to 96TWMXG.

Block numbe$ 10. I l. and l2: The cootractor shall revicw the plan annually lbr curency.

and ilneeded. resubmit to the Co\ernmcnt an) desired changes tbr acceptancc- lf rcjected.

thecontractorshallreviseandresuhrnitthedocumcntuithinl0rvorkingdarsltierrcccipL unless othenrisc directed b) the CO.

Block l4: Report shall be in electronic lbrmat compatible \\ith Microsoll O,licc XP or higher software or unless othen{ise dirccted b} the Govcrnment \rith thc following file name structurer CI)RL 4005+ "Namc". The deli!en tuclhod is b\ email.

96l WrMX(l I i'flc n'7.7. I

15. TOTAT + 0 2 0

G- PREPARED BY

laric Bra\rn(jr

H, DATE I, APPROVED BY J. DATE

18 ESTIMATEO

ot PagesDD FORM 1423.1 , FEB 2OO1 PREVIOUS EDITION MAY BE USED Page

OMB No. 0704 0188

(1 Data ltem) data sou.ces, gaihs.g and m.ini.'n'ng rh€ data needed, and compl€tnq a.d ,ev'ewinq the colecrion or ntormaron. Send commenrs regardns rhE bu.den esrm.re o, any orher aspeci ol ths colle.iion or 'nlormation, 'ncudlng .educ,ng the burden, lo ihe Oepa(ment o, Delense, Eieclrve Services Dtreclorate lO7O4 Ol8al. Respondenls should be aware rhat notwilhsr.ndinq .ny olher p,ov sion ol law, no person shall be subjeci to any penahy lor lailing io .ompry wirn 6 .ollecton ollnrormaton'tndoesnotdLspayrcurenrlyvalidOMa.onrolnumbs. Pl..t. do.or reiurn yoor to.m ro the.bov. organirarion S.nd compl.red tom to rh.

Govemho.! h&ino Conrr&ring Ofic.r ror the Cont.crPR No. lkted in Blocl E.

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

OTHER MISC

D. SYSTEM/ITEM

Aircrali !lainlenancc - Ilackshop

E. CONTRACT/PR NO.

FA21li6- l9-R-0001

F. CONTAACTOR

A006

2 TITLE OF DATA ITEM

Work l!furragcm.nt Phn

3 SUBTITLE

Contingenc) l'lan

4. AUTHOfiITY /Daia /A.qullion Docunent No )

DI-MGMT.8I9I IA

5, CONTRACT f,EfERENCE

P\\'S 6,] 961\\ \'IXG

NiA Sce Blk l6 12 OATE OF fIRST SUBMISSION

See Blk l6 ll

9, DIST SIAIEMENT

See Blk l6

13, OATE OF SUBSEOUENT

See Blk 16

96fU /MXG I

A.t,tliPZt I

15 TOTAL

0 21 0

Bik 4: Contractor Formal is Acceptable. The plan shall dctail how the contraclor will address crash rccovery. hydrazine response. and thc Maintenancc C)pcrations ( enter (M(X ) services perlbrmed under this contract as mission essential.

Block numhcrs 7 & 8: Conlrrclor's contingenc) contingenc) plan rvill bc rcr ie$ed and acccplcd or reiected b) thc (;o\ernment \\ithing 30 r\orkinS dals after a\rard ol-the contract. ll_rciccted the conlractor shall rcvisc and resubmil the documenl rlithin l0 working da)s at'ter receipt unless othcr\\isc directed b) thc ( O.

Blk 9: Distribution Code B: Distribution authorized to U.S. (iovemment Agoncies only (Proprietary lnformation)(25 Jul) 2014). Other rcquests for lhis document shall be referrcd to 961w/MxG.

Block numhcrs 10. ll.and l2: lhe contracor shallre\ic\\ the plan annuall) ldr currenc).

and ifnecded. resubmil to thc Go\emment an) desired changcs lbr acceptancc- lirejected.

the contractor shall revise and resubmil thc document $ithin l0 \torking dals aller rceeipl unless othcrwise directed by the CO.

Block l4: Report shall be in electronic lbrmat compatible \rith Microsoli Ollice XP or higher solirvare or unless othenvise directed b) the Co\ernmcnt $ith the follo\\'ing lile name struclure: CDRL 4006 + "Name". 'l hc delivery method is by email.

H, DATE I. APPROVED BY J. DATEG. PREPARED BY

Eric Brauner

II

ofDD FORM 1423-1, FEB 2OO1 PREVIOUS EOITION MAY BE USEO Page m f__l-r

----T--

--f-tl I tl+

E Pages

(l Data ltem) OMB No. 0704 0188 dat6 sources, grihding and m.inrahL.g the dara ne€ded, and compbnng and revewihg rhe.olleciion oi inlorm.tion. Send commenrs .egarding lh's burden estimale or anY orha aspecr ot rhis collecnon ol i.lormaton, Lnclud'no suggesl ohs lor reducinq rhe bu,den, ro rhe Oopanmenl o, O€lense, Erecutive SeNces On.crorale 10704 0188). Fesponde.rs should be aware thar nolwirhsland ng any orher p.ovision o, law, no pe.son sh.ll b€ sublecl to ..y pona ty lor fa'ring lo comply wth 6 collecrion ot informaton rl ir does noi dlspay a clrenlly valid OMB conl'olnumbe.. Pl.a* do nor t.ruh your lorm ro th..hove o.ganiz.rio.. S.nd comrl.r.d lom to rhe covemm.m lr.uing Conr.cting Oft...lor the Conrr..rPR No. ll.t.d h ab E.

A. CONTBACT LINE ITEM NO B, EXHIBIT C. CATEGORY:

TM orHER Mlsc

D. SYSTEM/ITEM

Aircrali \4ainlenancc - Backshop

E. CONTRACT/PR NO,

l .\2llJ6-I()-R (XX)r

F CONTRACTOR

A007

2. TITLE OF OATA ITEM

Work Managemen( I'lan Quality Control Plan

4. AUTHOifTY /Or,a -4cqu,!l)on Docuhent No )

DI-MCMT.8I9IIA

5. CONIRACT REFEFENCE

96TWi MXG

N,,A

I]

See Blk l(r

12 OATE OF FIRST SI]BMISSION

See Blk l6

See Blk l(,

13. DATE OF SUASEOUENI

See Blk l(r

BIk 4: Contractor Format is Acceptable. The Qualit)' ( onlrol Plan shall be in accordance r\ ith PWS Seclion 13.

Block nunlbers 7 & 8: Conlractor's conlingency conlingencv plan trill bc rc\ie\!ed and acceptcd or reiected b) thc (iovemment withing 30 working dals atlcr a\ard oflhe contract. ll rejected the contractor shall rc\ ise and rcsubmit lhe documcnt Nithin l0 uorking days after receipt unless other$ isc dircctcd b) Ihe CO.

BIk 9: Distribution Codc B: Distribution authorized to U.S. Governmcnt Agencies onl)-

(Proprielary Information)(25 July 2014). Other requests tbr this document shall bc rclbrred to 96TW/N4XC.

Block numbers 10. I l. and l2: The conlraclor shall rcrics the plan annualll for currcncl.

and ifnccded. resubmit to thc (iovcrnrncnl any desircd changes lor acccplance. Il rciected-the contractor shall re\isc and resubmit the document \vilhin l0 !\orkinS dals aficr r((cinr unless othcnr ise direcled b) the Co.

Block l4r Rcport shall bc in electronic lbrmat compatiblc \tith Microsoli Ofllcc XP or higher solhvare or unless othenvise directed b) the Co\ernment \\'ith the fbllorving lilc name struclurc: CDR[, 4007 + "Namc". lhe deliven nrethod is b\ emril-

I

At 1( tlJ/ / I

15 TOIAL _ 0 l 0

G. PREPARED BY

Eric Brawner

H, DATE I, APPROVED BY J. DATE

of PagesDD FORM 1423-1, FEB 2OO1 PREVIOUS EDITION MAY AE USED Page

PWS t-l tl

----T--

IT+

IT

T---r--l1 Data ltem) OMB No. O7O4 0188 data sourc.s, gathsng and malnla'n'hg ihe data needed,6nd compleaing and rev'.winQ ihe colecton oa mformato.. S..d commenrs ,ega,d ng ths bu,den estm.re or anv olher aspecr ol inlorm6rion, incudng sugg.slons ld reducinq rhe burd.., io rhe Depadment ol Delense, Execurve S€.vces Otrecror.re lOTOa 0r881. Respondents should be aware thal nolw'rhsiandrng any oihe, prov'sron of law, no pe,son shall be sub)ecr ro anv penalrv lo. ra'lnq ro comp y wth . collecl'on ol nto,manon

', 'r does nor dis9lay a .!(enily valid OMa contolnumber. P1.... do nor rerurn your lo.m ro th..bov. org.nirarion. Send.ompl.r.d lom to ih.

Gov.mment l..uinO Contacrinq Olficar tor ihe Conr.ci/PF No. lkt.d in Blocl E

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

X

D. SYSTEM/ITEM

Backshop

E- CONTRACTiPR NO.

F \2.186- 19-R-0001

F, CONTRACTOR

A008

2 TITIE Of OATA ITEM

Contractor Acquircd Propcrt) (CAP) Rcporl CAI'Rcporling tr, AUTHOiiTY /Orra /.qrlslion Docunent No.)

DI-MGMT-8O4.IIB

5 CONTRACI AEFERENCE

P\\'S 19 96 TSSQ/RNXC

7, DD 25O REO

LT

9, OIST STAT€MENT

u

Annually r2 oatE oF FrRsr suBMrssroN

Sce Blk l6

N/A

]3 OATE OF SUASEOUENT

suBMrssroN

See Blk l6

The Contractor shall provide a Contractor Acquired Propcrty (CAP) report IAW FAR

52.245-l for the delivery ofall CAP. The report shall be delivered electronicall) using MS

OfTice Exccl and structured !o allow lbr soning/tiltering ofdata. 'l he CAP Rcpo( cannot be scanned or laxed.

l he CAP Rcporl shall- al a ninimunl. inclLrdc thc tbllo\\ ing lields

a. Item Nam€ (Nomenclature)

b. ltem Description

c. Model Number (ifavailable)

d. Stock Number (NSN. no dashes) (ifavailable)

e. Part Nurnber (ifavailable) ll Serial Numbcr/tJII

g. Quaniit)'

h. Unir ol'Measure (e.g. LA. PR)

i. Unit Acquisition Cosl

j. Date Placed in Servicc

k. Contmctor Asset Tag Number (e.g. B#)

Blk 9: Distribution Code B: Dislribution aulhorized to U-S. (;o\ernment Agcncics onl) (Proprietary lnlormation)(25 Jull 2014). Olhcr requesls 1br this document shall bc rcl'ened to 96TW/MXC.

Block l2: lnirial Submission shall beNl-l i0 da\ s after thc ncNt fiscal \ear. I Oct20l8

,61SSQIRNX( 0 I 0

AI: ]CIPILB 0 I 0

15 TOTAL --'--.+ 0 0

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

PagesDO FORM 1423-1. FES 2001 PREV OUS ED T ON MAY BE USED Page

Block l3: Subscquent submissions lvill be Nl- I 30 days lion the beginning ol each fiscal year thereal'lcr. Final submission rvill be wilhin 90 days ol contract complclion/termination.

rT

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INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 50lO.12 M fot detailed insrructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self -explanatory.

ItamB. Self-explanatory.

Itom C. Mark (x) appropriate calegory: TDP Technical Data Package;

TM Technical Manuali Other other category of data, such as 'Provisioning," "Conliguration Management," etc.

llem D. Enter name of system/item being acquired that data will support.

Itom E. Sell-explanatory (to be filled in after contract award).

It€m F. SelI explanatory (to be filled in after contract award).

Itam G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Itom l. Signature of CDRL approval aulhority.

Itom J. Date CDRL was approved-lrem 1 See DoD FAR Supplement Subparl 4.71 for proper numbering.

Enter title as it appears on dala acquisition documenl ciled rn ltemItem 2 4.

hom 3. Enler subtitle of data item for fufther definition of data item {optional entry).

Item 4. Enter Data ltem Description (DlD) number, military specilication number, or military standard number listed in DoD 5010.12-L (AMSDL), or one time DID number, that defines data content and format requirements.

Item 5. Enter relerence to tasking in contract that generates requirement for the data ltem (e.g., Slatemenl of Work paragraph number).

Itam 6. Enter technical ofrice responsible for ensuring adequacy of the data item.

Item 7. Specily requirement for inspeclion/acceptance of the dala item by the Government.

It€m 8. Specify requirement for approval oI a draft before prepara'tion ol the final data item.

Itam 9. For technical data, specity requirement for contractor to mark the appropriale dis'tribution statement on the data (ref. DoDD 5230.24).

Itom 10. Specity number of times data items are to be delivered

Item 11. Spec fy as of date of dara lem, when app icab e

Item 'l2. Specify when first submitla s requ red

Item 13. Specify when subsequent submittals are required, when applicable.

It€m 14. Enrer addressees and number of dratt/final copies to be delivered 1o each addressee. Explain reproducible copies in ltem 16.

ltem 15. Enrer total number of draft/final copies to be delivered

Itom 16. Use for additional/clarilying information lor ltems 1 through 15.

Examples are: Tailoring of documents cited in ltem 4; Clarification of subminal dates in ltems 12 and 13; Explanation of reproducible copies in hem 14-; Desired medium for delivery of the data iiem.

Item 17. Specify appropriale price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group l. Definition - Data which is not otherwase essential to the conlractor's performance of the primary contracted eflort lproduction, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Governmenl requirements, and the administration and other expenses related to reprodocing and de rvering such dala items to the Government.

b. Group ll. Definition Data which is essential to the perlormance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard lo deplh of content, tormat, frequency of submiltal, preparalion, conlrol, or quality of the data ilem.

Estimated Price - Costs ro be included under Group ll are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group lll. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change lo conform to Government requirements with regard to depth of conlent, lormat, frequency of submittal, preparation, control, and quality of the data item.

Estimated Pric€ Costs 1o be included under Group lll are the administralive and olh€r expenses relaled 10 reproducing and delivering such data lem to the Government.

d Group lV. Definilion ' Data which is developed by the contraclor as pan ol his normal operating procedures and his effort in supplying these data to the Government is minrmal.

Estimated Price - Group lV items should normally be shown on the 0D Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that po(ion of the total price which is estimated to be attributable to the production or development for the Government o, thar item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred io performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contrac(-

DD FORM 1423.1 (BACK). FEB 2OO1

FOB THE CONTRACTOR