Appx_B_CDRLs_5_Dec_13.pdf

CDRL TITLE PWS Reference A001 Maintenance Control Plan 2.11.1/4.2.13/4.2.13.1/4.3.3.3/4.4.17.5 A002 Ancillary Report 2.12.2 A003 Environmental Protection Plan 2.25.1 A004 Annual Environmental Program Status 2.25.1 A005 Spill Report 2.25.1.1 A006 Safety & Health Plan 2.25.2.1 A007 Accident/Incident Report 2.25.2.3/2.25.2.4/4.1.2.4 A008 Progress, Status, and Management Report 2.26 A009 Airfield Management Plan 3.1.1.1 A010 BASH Monthly Status Report 3.1.2 A011 Joint Operations Center Plan 3.2 A012 Logistics OI Manual 4.1 A013 Fuel Report 4.1.1.9 A014 Life Cycle Plan 4.1.6.4 A015 Equipment Life Cycle Report 4.1.6.5/4.1.10k A016 Property Control Plan 4.1.7.3 A017 Metric of Cargo Movement Report 4.1.9.1 A018 Vegetation Ground MXS Plan 4.2.1.15 A019 Monthly Work Status Report 2.25.1.2/4.2.1.20.1 A020 Annual Facility Survey and Inspection Report 4.2.1.20.2 A021 Real Property Report 4.2.1.20.3 A022 CE Project Completion Report 4.2.2.1.3

A023 Communications and Information Systems Installation Records (CSIRs) 4.4.2

A024 System Circuit Information Guide 4.4.3.1.1 A025 Configuration Management Plan 4.4.8/ 4.4.16.4

A026 Communication Posture Report (COMSPOT) & Communication Status Report (COMSTAT) 4.4.18.1

A027 C4I Monthly Systems Report 4.4.18.2 A028 Financial Management Reports 5.4.2

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

FOL FA4890-13-R-0117

A001 Maintenance Support Plan Maintenance Control Plan

N/A See Block 16 ACC AMIC/PCE

LT

A B

See Block 16

See Block 16

45 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PCE 1

ACC AMIC/DRQM 1

ACC AMIC/PLG 1

ACC AMIC/PSC 1

AFSOUTH A6 1

0 0

5) PWS Paragraphs 2.11.1, 4.2.13, 4.2.13.1, 4.3.3.3, 4.4.2, 4.4.18.5

The contractor shall develop and implement a MCP IAW technical orders, commercial standards, applicable manuals, and FOL operational guidelines. The contractor shall administer MCP policies/procedures, instructions and implement the plan at all operating locations. The MCP shall identify the procedures used to document, schedule, and execute maintenance actions and logistics tasks to ensure all facilities and equipment are operated and maintained IAW the Performance Work Statement (PWS), Sections A & B and Section E, Appendix I. The MCP shall include procedures for scheduling, performing, and documenting Emergency, Urgent and Routine corrective maintenance (CM), Time Compliance Technical Order (TCTO), corrosion control program, and government-approved modifications.

The MCP shall include a master listing of all PM tasks with task references for all C4I, CE, RP, RPIE, RPSE, AGE and vehicles, as well as an annual PM schedule.

PM tasks in the annual schedule shall be categorized by site, vehicle, facility, system, equipment, and frequency of inspection. The contractor shall extend and comply with the maintenance schedule in place from the previous contract until the initial submittal and approval of the MCP.

8) The document will be accepted/rejected by the Government within 30 calendar days after receipt. Contractor shall revise and resubmit the document within 10 calendar days after receipt unless otherwise directed by the CO.

9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 17 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

10, 11, 12, 13) The projected annual PM schedule shall be based on fiscal year and submitted annually by 15 August for CO approval. The contractor shall review and update their plans IAW with the approved QMS. Coordinate at site level and obtain local concurrence prior to submitting for acceptance. All proposed revisions and/or amendments to the MCP shall be approved by the CO prior to implementation.

Submit to the CO for approval NLT 10 calendar days after revisions and/or amendments.

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A002 Ancillary Report N/A

DI-FNCL-81208 PWS Para 2.12.2 AMIC PMSF

LT

N/A B

Monthly

30 DAC

See Block 16

AMIC PKB 1

AMIC PMSF 1

0 0

5) This CDRL combines all deployed unit costs for unit support and services cost, shipments, and ES&H Cost - SEE EXAMPLE

9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to

AMIC PKB.

13) CDRL shall be submitted NLT 10 calendar days after end of the reporting period

Unit Name Unit Address Billing Address Point of Contact Email Address DSN & FAX No.

MIPR Not Received

From: TO:

Unit of Issue/Cost per unit Estimated Quantity/Cost Actual Quantity

Used/Cost

Subtotal $0.00

MH $0.00

Total $0.00

Printed Name/Title Date

Date

Supply

Signature, Unit Rep (Reciever of Goods)

FOL-BOS Site Manager

Cellular Phone - Calling Cards

Damaged/Lost Cell Phone or Pager

Cellular phone - Post Paid

Commercial Line - Post Paid

Lost Badge

Lavatory Services/AGE Support

Ground Fuel (SUPER) U Drive Vehicles

Billeting Service - Over flow - Marriott Hotel (Paid by the Unit with GTC)

Billeting Service - Over flow - Hilton Hotel (Paid by the Unit with GTC)

Billeting Service - Over flow - Clarion Hotel (Paid by the Unit with GTC)

Transportation - Rented Van (9 Pax) if U-drives unavailable - Paid with GTC

Transportation - Rented Cars if U-drives unavailable - Paid with GTC

Bottled Water

LOX

GOX

Gas Nitrogen

U-Drive Vehicles

Ground Fuel (Diesel) - U-Drive Vehicles

Billeting Services - Holiday Beach

Ancillary Support and Service Costs Curacao

Reimbursement Methods/MIPR Number

Services

EXAMPLE

E X

A M

P

LE

Sh ip pe d

By Sh ip pi ng N um be r

TC

N Ty pe S hi pm en t

O rig in De st in at io n O n Si te O rg an iz at io n

Sh ip pi ng

O rg an iz at io n

Sh ip

T o

Go od s D es cr ip tio n

Pr io rit y

W ei gh t

(lb s)

Vo lu m e

(ft 3 )

Ar r iv ed

Fr ei gh t

Fo rw ar de r Ac tu al

D el iv er y Da te In

-T ra ns it

Ti m e (D ay s)

To ta l C os t M at er ia l H an dl in g

Fe e

To ta l C os t

Unit Name:

Unit Address:

Billing Address:

Operator:

Point of Contact: GMV #:

DSN & FAX No.: Make:

Date of Mishap: Year:

Date of AIB:

Mishap Report #:

Actual Cost

$0.00TOTAL COST

Reimbursement Methods/MIPR Number:

Mishap Cost

FOL Curacao

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A003 Environmental Protection Plan

N/A PWS Para. 2.25.1 ACC AMIC/PCE

LT

N/A B

See Block 16

See Block 16

90 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PCE 1

ACC AMIC/DRQM 1

0 0

5) Plans shall include, but not limited to: Environmental, Safety and Occupational Health Compliance Assessment and Management Program (ESOHCAMP), Drinking Water and Waste Water System Management, Hazardous Waste Program, Hazardous Waste Collection and Disposal, Pollution Prevention Program, HAZMAT Program, POL, Air Quality Ozone Depleting Chemicals (ODCs), Pesticides and Herbicides Management, Special Health Considerations, Spill Prevention and Response, Environmental Impact Analysis Process, Training, and Environmental Protection Committee.

8) The document will be accepted/rejected by the Government within 30 calendar days after receipt. Contractor shall revise and resubmit the document within 10 calendar days after receipt unless otherwise directed by the CO.

9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to

ACC AMIC/PKB.

10, 11, 13) The contractor shall review and update their plans IAW with the accepted QMS. When a plan is revised it shall be submitted to the CO for approval NLT 10 calendar days after revision.

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A004 Annual Environmental Program Status

N/A PWS Para 2.25.1 ACC AMIC/PCE

LT

N/A B

Annually

1 Sept

15 Sept

14 Sept

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PCE 1

ACC AMIC/DRQM 1

0 0

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

5) Report shall be submitted in both electronic & paper copy format.. The report should include the information per the attached template, "A004 Annual Environmental Activity Report Template.docx".

8) The report will be accepted or rejected by the Government within 30 working days after receipt. If rejected, the contractor shall revise and resubmit within 10 working days after receipt unless otherwise directed by the Contracting Officer.

9) Distribution authorized to the Department of Defense and U.S. DoD contractors only for administrative or operational data; date of determination is xx xxx xx. Other requests shall be referred to ACC AMIC/PKB.

11) Since this report provides a projection of the annual status of the site at the end of the fiscal year but is due two weeks prior to the end, note any inspections or projected status that would be done in that two week period.

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

1096273912A Typewritten Text

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A005 Pollution Incident Report Spill Report

DI-SAFT-80494A PWS Para 2.25.1.1 ACC AMIC/PCE

LT

N/A B

See Block 16

See Block 16

See Block 16

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PCE 1

ACC AMIC/DRQM 1

0 0

5) The contractor will report any spills or releases of hazardous substances listed in 40 Code of Federal Regulations 302 that meet any of the conditions in Chapter 18 of the Overseas Environmental Baseline Guidance Document, DODI 4715.5-5. In addition, the contractor will report any contained releases that require the use of spill kits which would trigger a resupply action. The pollution spill report, with the addition of categories "actual damage/potential threat, findings and causes, casualties or injuries including personnel information, and assistance required," will constitute submission in IAW the OEBGD.

9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

10-13) CDRL shall be submitted NLT COB the next duty day and updates shall be provided as an addendum to the CDRL.

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A006 Environmental Health and Safety Plant Safety & Health Plan

DI-ENVR-81375 PWS Para 2.25.2.1 ACC AMIC/PCE

LT

N/A B

See Block 16

See Block 16

90 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PCE 1

ACC AMIC/DRQM 1

0 0

5) S&HP shall include, but not be limited to the following programs and procedures: Confined Space Management, Lock/Out-Tag/Out, Hazardous Communication (HAZCOM), Bird Air-Strike Hazard (BASH), Hazardous Air Traffic Reporting (HATR), Mid-Air Collision Avoidance (MACA), Weapons Safety, Aircraft Parking programs/plans, Job Safety Training, Safety Inspections, Mishap Notification, Investigation & Reporting Procedures, Hazard Abatement Procedures, and Hazard Prevention & Control Procedures, Safety Supplies and Equipment, Safety Reviews, Mishap Prevention as applicable.

8) The document will be accepted/rejected by the Government within 30 working days after receipt. Contractor shall revise and resubmit the document within 10 working days after receipt unless otherwise directed by the CO.

9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

10, 11, 13) The contractor shall review and update their plans IAW with the accepted QMS. When a plan is revised it shall be submitted to the CO for

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A007 Accident/Incident Report

N/A PWS Para 2.25.2.3, 2.25.2.4, 4.1.2.4 ACC AMIC/PCE

LT

N/A B

See Block 16

See Block 16

See Block 16

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PCE 1

ACC AMIC/DRQM 1

12AF/SE 1

0 0

5) Submit accident/incident information IAW AFI 91-204, Chapter 6 with follow-up information IAW Chapter 7. Report all events leading to lost duty time of personnel and/or any government vehicle damage that leads to a repair action.

Use ACC Form 164 Ground Mishap Report for all ground accidents and incidents.

Use AF Form 853 Air Force Wildlife Strike Report for BASH related reporting.

Other incident types shall be submitted on an advisory form identified in Appendix C (example: AF Form 651 (HATR)) or a contractor developed local form.

9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this report shall be referred to the CO, ACC AMIC/PKB.

10-13) Reports shall be submitted NLT COB next duty day and updates shall be provided as an addendum to the initial report.

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A008 Contractor's Progress, Status, and Management Report Progress, Status, and Management Report

DI-MGMT-80227 PWS Para 2.26 ACC AMIC/PMSF

LT

N/A B

Monthly

45 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/DRQM 1

AFSOUTH A6 1

612 SPTS 1

429 EOS/CC 1

0 0

5) Provide the overall program status, work progress and assigned tasks status.

Inform the government of existing or potential problem areas and possible solutions.

9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013.) Other requests for this document shall be referred to AMIC/PKB.

13) CDRL shall be submitted NLT 10 calendar days after the end of the reporting period.

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A009 Technical Report Study/Services Airfield Management Plan

DI-MISC-80508A PWS Para 3.1.1.1 ACC AMIC/PSC

LT

A F

See Block 16

See Block 16

60 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PSC 1

ACC AMIC/DRQM 1

ACC AMIC/PCE 1

0 0

(5) Airfield Management Plan/Operating Instruction shall include, but not be limited to: Roles and Responsibilities, Facilitation of Airfield Operations Board, ATC Function, ATC Position Qualification, Airfield Lighting System Management, Foreign Object Damage (FOD) Function, Bird Air-Strike Hazard (BASH), Hazardous Air Traffic Reporting (HATR), Mid-Air Collision Avoidance (MACA), Runway Rubber Removal/Painting Plan, Flight Line Driving Certification Functions, Aircraft Parking Plan, Tracking of Flights, Mission Planning Support, and NOTAM/FLIP Functions. Reference AFI 13-204v3, Attachment 2.

(9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

(10, 11, 12, 13) The contractor shall review and update their plans IAW the accepted QMS. Coordinate at site level and obtain local concurrence prior to submitting for acceptance. When a plan is revised, it shall be submitted to the CO for approval NLT 10 calendar days after revision.

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A010 Bird/Wildlife Aircraft Strike Hazard (BASH) Report BASH Monthly Status Report

DI-MISC-81489 PWS Para 3.1.2 ACC AMIC/PSC

LT

A B

Monthly

30 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PSC 1

ACC AMIC/DRQM 1

ACC AMIC/PCE 1

0 0

5) Provide the overall program status, work progress, and assigned tasks status in accordance with 429th Expeditionary Operations Squadron Curacao Bird/Wildlife Aircraft Strike Hazard (BASH) Plan 91-202 and inform the government of existing or potential problem areas and possible solutions.

9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

(12,13) Coordinate at site level and obtain local concurrence prior to submitting for acceptance. CDRL shall be submitted NLT 10 calendar days after end of the reporting period

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A012 Operating Instructions Logistics OI Manual

DI-MISC-80392 PWS Para 4.1 ACC AMIC/PLG

LT

A B

See Bloc 16

See Block 16

60 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PSC 1

ACC AMIC/DRQM 1

ACC AMIC/PCE 1

ACC AMIC/PLG 1

AFSOUTH A6 1

0 0

(9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

(10, 11, 13) The contractor shall review and update their plans IAW the accepted QMS. When a plan is revised it shall be submitted t the Contracting Officer for

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A013 Technical Report Study/Services Fuel Report

DI-MISC-80508A PWS Para 4.1.1.9 ACC AMIC/PLG

LT

N/A B

Monthly

30 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PLG 1

ACC AMIC/DRQM 1

0 0

(5) The fuels report shall include, at a minimum; total quantity of aviation fuel, ground fuel, and liquid oxygen provided per month broken out by user. The report shall also be accompanied by the corresponding DD 1348-8.

(9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

(13) CDRL shall be submitted NLT 10 calendar days after the end of the reporting period.

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A014 Equipment Inventory Records Life Cycle Plan

DI-ILSS-81251 PWS Para 4.1.6.4 ACC AMIC/PLG

LT

N/A B

Annually

31 Mar

31 Mar

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PLG 1

ACC AMIC/DRQM 1

ACC AMIC/PCE 1

ACC AMIC/PSC 1

0 0

(13) CDRL shall be submitted NLT 10 calendar days after the end of the reporting period.

(5) The inventory shall be broken down into sections according to type of property (i.e., consumable, equipment, reparable, ADPE, TMDE, etc.). The report shall include the following fields as a minimum:

- P/N

- National Stock Number (if applicable)

- Nomenclature

- Serial Number

- Model Number

- Unit of Issue

- Quantity

- Unit Price

- Location

- Shelf Life Code

- Repair Code (Equipment Category)

- Equipment Serial Number

- Stock Level Quantity

- Date Of Last Inventory

- Date Property Assigned to Inventory List

(9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A015 Technical Report Study/Services Equipment Life Cycle Report

DI-MISC-80508A PWS Para. 4.1.6.5/4.1.10k ACC AMIC/PLG

LT

A B

Monthly

30 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PLG 1

ACC AMIC/DRQM 1

0 0

4) Excel Spreadsheet

5) The report shall include at a minimum; Vehicle registration numbers and vehicle type, WO#, start/stop dates, Stock Number (if applicable), part number, Nomenclature, Quantity, Source of Supply, cost, repair cost, unit of issue, current life expectancy.

(9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

13) CDRL shall be submitted NLT 10 calendar days after end of the reporting

ESN NOUN NSN PART # SER #

QTY ON

HAND

QTY

AUTH COND STATUS

PHYSICAL

LOC PRICE SITE CATEGORY TYPE ACQ DATE

LIFE CYCLE

(FY) WARRANTY

DISPOSAL

DATE DOLI

EST REPL

PRICE

A000211 SHREDDER 7110L00000023 0000000000 A951036 1 1 A FMC SUPPLY OFFICE $618.00 CUR OEL-OFFICE OEL 1/5/2010 2019 EXP 701.00$

A000212 REFUELER 2620P00000010 MFC 7220 E63450M7N322911 1 1 A FMC REFUEL PAD $90,385.00 CUR SP VEHICLE CACRL 1/11/2010 2025 1/11/2013 110,003.98$

A000011 6 PACK 2620P00000011 HILIFT E20189877 1 1 A FMC COR $24,000.00 ARUBA GP VEHICLE CACRL 1/11/2010 2020 EXP 25,000.00$

TOTALS $115,003.00 $135,704.98

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A017 Technical Report Study/Services Metric of Cargo Movement Report

DI-MISC-80508A PWS Para 4.1.9.1 ACC AMIC/PLG

LT

N/A B

Monthly

30 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PLG 1

ACC AMIC/DRQM 1

0 0

5) The report shall include as a minimum; Movement of cargo by tonnage, cost, and percentage on time delivery, and dates, frustrated cargo and in-transit time.

9) Distribution authorized to U.S. Government agencies only (administrative or operational data). Other requests for this document shall be referred to ACC

AMIC/PKB.

13) CDRL shall be submitted NLT 10 calendar days after the end of the reporting period.

14) Metrics shall be in Bar Graphic Excel Spreadsheet format.

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A018 Vegetation Ground Maintenance Plan

N/A PWS Para. 4.2.1.15 ACC AMIC/PCE

LT

N/A B

See Block 16

See Block 16

90 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PCE 1

ACC AMIC/DRQM 1

0 0

5) The plan shall include procedures for effective vegetation management, proper use of resources, and scheduling to allow for any licensing, permits or other permissions to accomplish these tasks. Plan will include the overall schedule for this maintenance and will provide flexibility to respond to changing conditions.

8) The document will be accepted/rejected by the Government within 30 calendar days after receipt. Contractor shall revise and resubmit the document within 10 calendar days after receipt unless otherwise directed by the CO.

9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 18 Jun 2013). Other requests for this document shall be referred to ACC AMIC/PKB.

10, 11, 13) The contractor shall review and update their plans IAW with the accepted QMS. When a plan is revised it shall be submitted to the CO for acceptance NLT 10 calendar days after revision..

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

X

FOL FA4890-13-R-0117

A019 CE Monthly Work Status Report

N/A PWS Para. 2.25.1.2/4.2.1.20.1 ACC AMIC/PCE

LT

N/A B

Monthly

45 DAC

See Block 16

ACC AMIC/PKB 1

ACC AMIC/PMSF 1

ACC AMIC/PCE 1

ACC AMIC/DRQM 1

AFSOUTH A6 1

0 0

5) The report shall include: PM tasks not accomplished as per annual maintenance schedule, CM tasks accomplished, the status of all outstanding CM tasks, and the status of identified 332 project requirements. Report will be in MS Excel format with the following fields: Work Order, Job Description, Equipment and Facility being worked on, WO status (i.e. open, closed, etc.), Downtime status (i.e. AWM, AWP, etc.), WO start date, WO completion date (as applicable), ETRO (as applicable) and comments sufficient to describe the current situation of the WO.

5) This report shall also include any pesticide/herbicide usage as a CM…