FA8509-12-R-32444-0006.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE Page 1

2. AMENDMENT/MODIFICATION NO.

FA8509-12-R-32444-0006

3. EFFECTIVE DATE

15 NOV 2012

4. REQUISITION/PURCHASE REQ. NO.

FD20601232444

5. PROJECT NO (If applicable)

6. ISSUED BY CODE

SOF/PR - FIXED WING & ENG SUPPORT, AFLCMC/WIKAA

235 BYRON ST STE 19A

BLDG 300 CML PHN 478 926 2208

ROBINS AFB GA 31098-1670

BUYER: Beckie G King/GRUKA Beckie.King@robins.af.mil Phone: (478) 926- 2746 Fax: (478) 926-3360 No Collect Calls

7. ADMINISTERED BY (If other than item 6) CODEFA8509

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

CODE

X

9A. AMENDMENT OF SOLICITATION NO.

FA850912R32444

9B. DATED (SEE ITEM 11)

10-OCT-2012

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers is extended, is not extended. Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods. ( a ) By completing Items 8 and 15, and returning copies of the amendment; ( b ) By acknowledging receipt of this amendment on each copy of the offer submitted; or ( c ) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified. 21-NOV-2012 10:00 PM

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return 1 copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

ROUTINE

15A. NAME AND TITLE OF SIGNER (Type or print)

15B. CONTRACTOR/OFFEROR

BY ________________________________________________________

(Signature of person authorized to sign)

15C. DATE SIGNED

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16B. UNITED STATES OF AMERICA

BY ____________________________________________________

(Signature of Contracting Officer)

16C. DATE SIGNED

FACILITY CODE

NSN 7540-01-152-8070

PREVIOUS EDITION UNUSABLE

30-105 STANDARD FORM 30 (REV. 10-83)

PRESCRIBED BY GSA

FAR (48 CFR) 53.243

X

X X

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

Amendment/Modification FA8509-12-R-32444-0006

Continuation of block 14. DESCRIPTION OF AMENDMENT/MODIFICATION

The purpose of this amendment is to state firm date for receipt of proposals, incorporate references to AC-130W Stinger Aircraft, formally known as the MC-130W Combat Spear Aircraft, restate Data SUBCLINS 0041AA thru 0014AG, delete SUBCLIN 0041AH, delete DD Forms 1423 under Section J dated 12 Jul 2012 and replace with attached DD Forms 1423, re-dated 15 Nov 2012, delete DD250 under Section J, dated 3 Jul 2012, and replace with attached DD250 dated 15 Nov 2012.

a. Receipt of Proposal (RFP) is changed From: Indefinitely To: 21 November, 2012, 10:00 AM EST

b. All reference to the MC-130W Combat Spear Aircraft, or reference to MC-130W is hereby changed and applicable throughout RFP Schedules B, L, and M, and all attachments to RFP.

MC-130W Combat Spear Aircraft or MC-130W is now designated as the AC-130W Stinger II Aircraft or AC-130W.

c. Data SUBCLINS are hereby restated as follows (see page three)

d. Data SUBCLINS 0041AH, 1041AH and 2041AH are hereby deleted.

e. DD Forms 1423-1 (CDRLS), Atch 2 Contract Data Requirements List, ELINS A001 – A007, dated 12 Jul 2012 are hereby deleted and replaced by Atch 2 Contract Data Requirements List, ELINS A001 – A007 re-dated 15 Nov 2012, under Section J, Lists of Attachments, as attached to this amendment.

f. DD 254, Atch 10 DoD Contract Security Classification Specification dtd 3 Jul 2012 is hereby deleted under Section J, Lists of Attachments, as attached to this amendment. See changes in Blocks 10, 13, 16, and continuation sheet.

g. The following attachments are hereby incorporated into Section J, Lists of Attachments.

Section J Lists of Attachments

Form Number Description/File Name Date Number of Pages

DD Form 1423-1 Atch 2 Contract Data Requirements List Re-dated 15 Nov 2012 7

DD 254 Atch 10 D0D Contract Security Classification Specification

15 Nov 2012 4

h. End of Amendment.

Request for Proposal FA8509-12-R-32444-0006

PART I - THE SCHEDULE

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

Data CLINs 0041AA-AG, 1041AA-AG, 2041AA-AGH as stated in solicitation FA8509-12-R-32444 are hereby restated as shown below:

Data CLINs 0041AH, 1041AH, and 2041AH are hereby deleted.

Data

Item No.

Firm Fixed Price

Exhibit: A

Delivery IAW DD 1423-1

Data - Conference Agenda

Item No.

0041AA

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A001

Conference Agenda DI-ADMN-81249A Exhibit: A

Data - Conference Minutes

Item No.

0041AB

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A002

Conference Minutes DI-ADMN-81250A Exhibit: A

Data - Status Report

0041AC

Data - Status Report

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A003

Status Report DI-MGMT-80368A/T Exhibit: A

Data - Accident/Incident Report

Item No.

0041AD

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A004

Accident/Incident Report DI-SAFT-81563/T Exhibit: A

Data - Environmental Health and Safety Plan

Item No.

0041AE

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A005

Environmental Health and Safety Plan (HSP) DI-ENVR-81375 Exhibit: A

Data - Accident/Incident Report

Item No.

0041AF

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A006

Accident/Incident Report DI-SAFT-81563/T Exhibit: A

Data - Quality Program Plan

Item No.

0041AG

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A007

Quality Program Plan (QPP) DI-QCIC-81722

Data

Item No.

Firm Fixed Price

Data - Conference Agenda

1041AA

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A001

Conference Agenda DI-ADMN-81249A Exhibit: A

Data - Conference Minutes

Item No.

1041AB

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A002

Conference Minutes DI-ADMN-81250A Exhibit: A

Data - Status Report

Item No.

1041AC

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A003

Status Report DI-MGMT-80368A/T Exhibit: A

Data - Accident/Incident Report

Item No.

1041AD

Firm Fixed Price Quantity U/I Unit Price Amount

Data - Accident/Incident Report

1 LO

ELIN A004

Accident/Incident Report DI-SAFT-81563/T Exhibit: A

Data - Environmental Health and Safety Plan (HSP)

Item No.

1041AE

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A005

Environmental Health and Safety Plan (HSP) DI-ENVR-81375 Exhibit: A

Data - Accident/Incident Report

Item No.

1041AF

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A006

Accident/Incident Report DI-SAFT-81563/T Exhibit: A

Data - Quality Program Plan (QPP)

Item No.

1041AG

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A007

Quality Program Plan (QPP) DI-QCIC-81722 Exhibit: A

Data

Item No.

Firm Fixed Price

Data - Conference Agenda

Item No.

2041AA

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A001

Conference Agenda DI-ADMN-81249A Exhibit: A

Data - Conference Minutes

Item No.

2041AB

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A002

Conference Minutes DI-ADMN-81250A Exhibit: A

Data - Status Report

Item No.

2041AC

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A003

Status Report DI-MGMT-80368A/T Exhibit: A

Data - Accident/Incident Report

Item No.

2041AD

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A004

Accident/Incident Report DI-SAFT-81563/T Exhibit: A

Data - Environmental Health and Safety Plan

Item No.

2041AE

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A005

Data - Environmental Health and Safety Plan

Environmental Health and Safety Plan (HSP) DI-ENVR-81375 Exhibit: A

Data - Accident/Incident Report

Item No.

2041AF

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A006

Accident/Incident Report DI-SAFT-81563/T Exhibit: A

Data - Quality Program Plan

Item No.

2041AG

Firm Fixed Price Quantity U/I Unit Price Amount

1 LO

ELIN A007

Quality Program Plan DI-QCIC-81722

CONTRACT DATA REQUIREMENTS LIST Form Approved (1 Data Item) OMS No. 0704-0188

The publte rePQrtlng burden for this eolle~;tlon of information is estimated to average 110 hours pet response, including the time tor reviewing inJtruc:tions~ searching ex:lsq data souu:es. gathering and mamtai:niog the dat.a n.eded, and completing and revi.ewing thllt co~leet.iors cf infOtmation:. S.nd cornmentc r.gard."g 111;. burden utimat41 or any other aspect of this collection of in1ormation, including suggestions for reducing the burden, to the Department of OefiiiiOU, Exeeutiv• S.rvic•s Directorate \0704·0188), Rtrapondenta ohoukt bt aw•re that notwith5tanding any other proviuion of law 1 no person shall be subject to any penalty fot tamng to c.ompty wfth • oolltctlon ot u,tormatl.on rt 1t do•s not display a currently vafld OMS control nu.mbet, PJ&ue do not return your form to th• •bove organization. Send compl.nd fotrn co 'the Governmant !swing Contracting Officer for the ContraetfPR No. liatad jn Bloclc E.

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

OOL.\\~A_ TOP TM OTHER X

'•••w•••••

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

Advisory and Assistance Services FD2060-12-32444

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITI.f

AOOI Conference Agenda

4. AUTHORITY {Data AcqtHsitwn Docum~mt N<1.J ,5. CONTRACT REFERENCE 8. REQUIRING OFFICE

Dl-ADMN-81249A PWS 4.3 WR-ALC/GRUAG

1. DO 260 REO 9. DIST STATEMENT 10. FREQUENCY 1 2. DATE Of FIRST SUBMISSION 14. DISTRIBUTI!m

LT

REQUIRED

See BLK 16 See BLK 16 b. COPIES

B. APP CODE c 11. AS Of OATE 13. DATE OF SUBSEQUENT a. ADDReSSEE Fil'laJ SUBMISSI!m Or•h N/A SeeBLK 16 See BLK 16 R.g R•pro

16. REMARKS SeeBLK 16 2 BLOCK 7: TilE GOVERNMENT WILL ACCEI>T Tl IE RECEIVING REPORT TIIROlJGII WIDE AREA WORKFLOW (WAWF). CONTRACTOR SHALL SUBMIT HNAL REPORT TO AITENTION: daniela.petcrson@robins.af.mil FOR DATA PREVIOUSLY SUBMITTED BY LETTER OF TRANSMITrAL. THE GOVERNMENT

WILL APPROVE !DISAPPROVE WIT!IIN 5 WORKDAYS OF RECEIPT.

BLOCKS 8. 10-13: CONTRACTOR SHALL SUBMIT CONFERENCE AGENDA NO

!.A l'ER THAN 15 WORK DAYS PRIOR TO SCHEDULE MEETING FOR (iOVERNMENT REVIEW AND CONCURRENCE. GOVERNMENT WILL APPROVE

OR DISAPPROVE WITHIN 5 WORKDAYS. CONTRACTOR SIIALL DELIVER

FINAL AGENDA NO LATER TIIAN 5 WORK DAYS PRIOR TO SCHEDULE

MEETING IF CHANGES WERE DEEMED NECESSARY BY TilE GOVERNMENT.

BLOCK 14: SUBMIT VIA ELECTRONIC MEDIA.

danicla.petcrsonr(l)robins.aCmil david.millcr4ra)robins.at~mil

15. TOTAL 0 2 0

G. PREPARED BY H. DATE

'·~:: /£br-

J. DATE

Daniela Peterson, Program Manager 28 Jun 2012 ll:Ntl~ DO FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BErED. Page of Page$ -- --Ado!le Proteuional7.0

17. I'FIICE GROUP

111. ESTIMATED

TOTALPRlCf

CONTRACT OAT A REQUIREMENTS LIST Form Approved ( 1 Data Item) OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMS 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:

0041 A5 TOP TM OTHER X

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

Advisory and Assistance Services FD2060-12-32444

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

A002 Conference Minutes

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

DI-ADMN-81250A PWS 4.3 WR-ALC/GRUAG

7. DO 260 REO 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED See BLK 16 See BLK 16 b. COPIES

B. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft N/A See BLK 16 See BLK 16 Reg Repro

16. REMARKS See BLK 16 2 Block 7: The Government will accept the receiving report through Wide Area Workflow (WA WF). Contractor shaH submit final report to attention: daniela.peterson@robins.af.mil for data previously submitted by letter of transmittal. The Government will approve/disapprove within 5 workdays days of receipt.

Block 10-13: Due NLT 7 work days after each Conference/meeting. Government will review minutes and approve or disapprove within 5 work days. Contractor shall have 5 work days to incorporate comments and resubmit if changes were deemed necessary by the Government.

Block 14: Submit via electronic media.

daniela.peterson@robins.af.mil david.miller4@robins.af.mil

15. TOTAL 0 2 0

G. PREPARED BY H. DATE 'l];;;, BY/J J-L4-

J. DATE

28 Jun 2012 7 A/OJ 12 Daniela Peterson, Program Manager 7~

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MVE USED. Page of Pages

Adobe Professional 7.0

I

I

I

I

I

I

I

I

I I i

I i

17. PRICE GROUP

! 18. ESTIMATED

TOTAL PRICE

(1 Oata Item/ OMB No. 0704-Qt88

The public reportin.g burden for this eo-ll•etfon of information is. t~stimated to qverage .1 10 Mura per response, including the time for revi.wing insttuctiona .. uarching •xisting da-t,a; $own;;:e-s~ gat.harmg: aod maintall'\ing the data n.eded, and completing and review1ng: the colt.c:thm of informlltlon, Ser;d coml'niJJ'IU. regarding this burd•n e.Jtim•t• or any other as,;po-ct of thia conec:t•on of information, tncluding &uggestions for reducing the burden, to the De-part,...nt of O•f•n.u. Executive SllfViees DiteetOrlte (0704~0188}. Re&pondef'lt11 s.hould b• -aware that notwrthatM\ding any othecr provision of f•w. no poraon shall be- subject to any ~na-lty for falling to ~mply wfth • c~lection of intormat1on t1 !t -dolt' not display a curr•ntJy valid OMS c.ontro~ numb•t. Please do net return your form to the ahow organization. Send compteted f0f1Yl to the GoV"ernment ls.uing Contracting Offic•r fm th• ContractlPA No. listMI in Bloc:k E~

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

~ Oo4tAC.. TOP TM OTHER X -

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

Advisory and Assistance Services FD2060-12-32444

1. DATA ITEM NO. Z. nTLE Of' DATA ITEM 3. SUBTITLE

A003 Status Report Monthly Status Report

4. AUTHORITY ID•t• Acqui»ition DucumfMt Nt;.) ,6. CONTRACT REFERENCE 11. REQIJIRING OFfiCE

DI-MGMT-80368Aff PWS 4.4, 4.8, 4.15.1, 4.15.2 WR-ALC/GRUAG

7. OD 250 REO 9. DIST STATEMENT 10.FREQUENCY 1Z. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED

Monthly 30ARO b. COPIES

8. APP CODE c 11. AS OF DATE 13. ~~~::'s~:sEQUfNT •· ADDRESSEE Final i Draft A I See BLK 16 Sec BLK 16 Reg R•pro

16. REMARKS SceBLK 16 .2 2 Block 7: The Government will accept the receiving report through Wide Area Workflow (WAWF). Contractor shall submit final report to attention: daniela.pcterson@robins.af.mil for data previously submitted by letter oftransmittal. The Government will apprme/disapprove within 5 workdays days of receipt.

Block 8,10-13: Monthly Status Report is due NLT ten (10) workdays after the beginning of each month and shall cover the activities of the previous month. Report is du~ each month fi.Jr the life of the order. The <lovcmmcnt will approve or disappruvc \vithin 15 workdays.

Contractor shall have 5 workdays to incorporate changes and resubmit. Trip report is due NLT 11vc(5) working days after completion of traveL mock 14: Submit via electronic media.

danicla.pcterson(t~irobins.af.mil david.millcr4@robins.af.mil

15. TOTAL 2 2 0

G. PREPARED BY H. DATE

I. zr.ROVED Bt..f -

J. DATE

28 Jun 2012 I Z. -;Nf Daniela Peterson, Progmrn Manager ?~ L~ Z<h'Z- DO FORM 1423-1, FEB 2001 PREVIOUS EDITION M'YJBE USED. Page of· Pages -- --Adobe Ptoleuionaf 7.0 i i i

17. PRICE GROUP

18. ESTIMATED

( 1 Dsts Jrem) OMS No. 0704-0188

Thit publk:. reporUng but den for this coUecdon of information is ostimat•d to average 110 hours per rtaponse, tnetud~n,g the ttm• for reviewif"''g instructions, 1e1rchit:~g •xi sting data aoote•$, gllthermg and maint8i:ning the- data needed, and completing and reviewing th• coU&e::tlon ct inform-ation. Send c:ommerrta rqardinQ thiS burden ntimate or any othttt asp•ct of thi~ colleetion of informationf inetuding su:ges:tlons for reducing t"'- burden. to the Department of D•fenu~ Executiw Service& Directorete 10704·018~), Respo.nd•nu sh~uld bit •ware tt'tat no-twi'chstan ing any other ~ovision crl tew1 no pors.on ch.JI be subject to any pen~~tty for ta•fing 1:0 ~ompJy With • colJection of 1nforrna-tu;m 1f it does not d•~play s cuH8f'ltfy vahd OMS control number. ...,_ do not return your form to tiM above organiartlon. $end completed fotm to the Government 1••-uing Contracting Officer for the ContractJPR No. listed in Block E.

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

XSAFT ot\\t 1\'Y TOP TM OTHER

D. SYSTEM/ITEM I E. CONTRACT/PH NO. F. CONTRACTOR

Advisory and Assistance Services PD2060-12-32444

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

A004 Accidcnt/lncidcnt Report Mishap Notification and Reporting

4. AUTHORITY ID•t•llcqui•ition Documcnl No./ ,6. CONTRACT REFERENCE 6. R£QUIRINQ OFRCI!

DI-SAFT-81563/T PWS para 4.23.2 78ABW/SE

7. DO 250 REQ 19. OIST STATEMENT 10. F!IEOUENCY 12. DATE OF FIRST SUBMISSION 14. OISTliiBUTION

I REQUIRED As Required As Required DO I b. COPiES

8. APP CODE

B

11. AS OF DATE 13. ~~~~:~u..BSEQUENT a. ADDRESSEE Fin•!

N/A Draft See BLK 16 AsReq R<og Repro

16. REMARKS 78AUW/SEG I

Block 4: Contractor shall submit a report on ALL mishaps, damage to DoD property, and 675 Seventh St employee injury. to the Installation Safety Office telephonically within tour (4) hours after Bldg707 initial notification. Written report shall be submitted within three (3) calendar days of RAI'U,GA 31098 mishap. Electronic submissions arc acceptable. Information that is not available at the time 478-926-6271 of the initial notilication shall be pnwided within 20 calendar days alter the mishap. See Block 16 for email address Block 7: WA WF ACCEPTOR: The Government will acl.'ept the Receiving Report through W A WF. Contractor shall submit Receiving Report upon each submission PrimruyCOR I

See Block 16 tbr Block 9: Distribution authorized to US Gov.::rnment agencies only. Other requests for this email address document shall he rc1errcd to 78 ABW/SE.

Block 11; Submit written report within 72 hours of mishap.

78abw.se.mishap(a;rohins.af.rnil ('OR- danicla.pctcrson(a)robins.at:mil

15.TOTAL 0 2 0

G. PREP'ARED BY H. DATE l.aROVEDBY J.DATE

Daniela Peterson, Program Manager 28 Jun 2012 ~lk IZ,J:JI Zctz..

DO FORM 1423-1. FEB 2001 PREVIOUS EDITION MA-E USED. Page of Pages

17. P!IICE GROUP

CONTRACT DATA REQUIREMENTS LIST Farm Approved (1 Data Item) OMB No. 0704-0188

The public report1ng butct.n for thJs c:oflecti.on of if' formation is tiUmated to aver~ge 1 10 hours pu rtl$J)onse, including th• time for r•viewing inatrvctions. se•ehin; elf.iating deta sou:rciirt, gathe.nl'g .and m.aintain1ng th•. data nHded, and e~>mpkntns and revtewin; the c;.olt.c:tion of inform•tion. Sand commenTS reqarding th,_ burden estimate or •nv othtrr •s.pe.ct of th:Js (;OUection of !ntorma~on1 including sug98stions for redueit~g. the burden, to thtl Department af D•ft.rlh, EXKUtive Servic;:es. Directorate f0704·01S~t. Respondents should be •war• that notwrthstandiMi •nv otller provtston of law, no person ;hall be subject to any pen1h:v for failing to comply wfth a toUoc:tion of !rlformat1on. if it d041'G not display a eu,..,.ntiy valid OMB '¢Ontrot number. PS.•u do not r•tum your fonn 10 the ebow otganll:.ation. Send compa.c-.ci fonn to the Government lu!Jing Contracting Officer for the C-t!PR No. listed In Block E.

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

DD41 A£ TUP

~ ... TM .. OTHER

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

Advisory and Assistance Services FD2060-12-32444

1. DATA IUM NO. 2. TITLE OF DATA ITEM 3. SUBTIT1.E 17. PRICE GROUP

A005 Environmental llcalth and Safety Plan (HSP) Safety and llealth Plan j

4. AUTHORITY llht• Acquisition Oocumtmt No.! ,6. CONTRACT REAli!EJIICE f. REQUIRING OFFICE

DI-ENVR-81375 Appendix C, PWS Para. 4.23.4 WR-ALC/GR.UAG

.·1~8-. '!"ES~T~IM~A~TE~D

i TOTAl. PRI(A;

1. 00 250 R!;Q 9. DIST STATEMENT 10. FREQUENCY 1:(. DATE OF FIRST SUBMISSION 14. OISTIIIBUTIOH

DD

REQUIRED

See BLK 16 SecBLK 16 b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. AOORESSE:E Final D SUBMISSION Ore It A See BLK 16 SeeBLK 16 Reg Repr•

16. REMARKS 78 ABWISF.G 1 I

Blocks 4 & 5: Contractor tbrmat is acceptable. Contractor shall submit a Safety and llealth 675 Seventh St Plan in accordance with the clements listed in Appendix C. Bldg707

RAFB, GA 31098

Block 7: The Govcnuncnt will accept the Receiving Report through WA WF. Contractor 478-926-6271 shall submit the Receiving Report upon final submission.

Program Manager I 1 Hlock 8. 10. 12: Contractor shall submit a Health and Safety Plan within 10 working days See Block 16 tbr a tier c{)ntract award. Written Government approval/comments/disapproval will be within 1 U email address working days a11cr receipt of data. Contractor final submission shall be submitted within 10 working days of receiving Government comments. Approval by the Government is required Alternate COR I 1 prior to f(mnal distribution. See Block l6for email address Block 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only. Other requests shall be referred to the contraL't management team. WR-ALCIGRUKA, 235 Byron St .. Suite 19A. Robins AFB. GA 31098

Block II. 13: If, during the perfhrmance of this contract, changes to the Safety and Health Plan arc required, submit the revised Safety and Health Plan to WR-ALC/GRUAG and the Safety Olliec. 78 ABW/SEG. Procedures identified for blocks 8, 10-12 will apply.

Block 14: Procurement Olli~:er(s) e-mail along with Integrated Product Team t.~mail distro list will be provided as required. Electronic media shall be provided by CD!l>VD media in Microsotl Office compatible format.

7!!abw.sc.mishap!f~robins.af.mil danicln.pctcrsonia}robins.armil david.miller4(ri;robins.af.mil

1&.TOTAL 3 3 0

G. PREPARED BY H. DATE

l.c;::BYo~ J. DATE j

Daniela Peterson, Program Manager 28 Jun 2012 /Z.. $/ ltJ I Z, DO FORM 1423-1, FEB 2001 PREVIOUS EDITION MA YIE USED. Page of Pages -- --A<lobe F'rolllelional 7.0

CONTRACT DATA REQUIREMENTS liST Form Approved (1 08ta Item} OMS No. 0704-0188

The public repo,tmg bi.Jfden for th1s collection of information is eatimate<f to everage 1 10 I'KuJt& per response, including the time far revlewJng in.stfuetions •. searching ~txisting data sources~ o.ath&.ring ar~d maintatnji"''SJ fh• .-data neededf and eom~letirtg and ~"eviewing the coUectton of tnformation. Send <:cmme11u- regar<flng t~is bl.!rden. estimate- or any other .upe-t:t of thts eonec.l,on of informatton, lnc:fudtng !;UQgl!lst•oN· for reducing th• tu,o~rd•n, to the Oepattrnent oi Defense. ExecutN• Servicft Oirectorat.

10104·0188). Respondent,.s shoufd be aware that notwfthstandin.g any other provision of law. no per.son d't.alf be subjlct to Wly penarty for failing to c;ompty with a collection of 11'\format:Jon if tt doel:i not displ.y a curr•rrt1v valid OMB conttol number. Plu•• do not Nltum your tOfm to th• abov• orgwtization. $end campJtted fom1 to the Government fssuing Contracting Officer fot th• ContractJPR No. list•d In Blqok E.

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

OoYJ~F= TDP TM -· OTHER

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

Advisory and Assistance Services FD2060-l2-32444

1. DATA ITEM NO. 12. TITlf Of DATA IUM 3. SUBTITLE

A006 I Accident/Incident Report TICR!DART (Total Incident Case Rate/Days Away

Restricted Transfer)

. 17. PRICE GROUP

4. AUTHORITY (Dsta Acquis/1/t>n {)ocum<mt No./ ]6. CONTRACT RUEREIIICI: &. REQUIIIING OfFICI!

DJ-SAFT-81563/T PWS Para. 4.23.5 WR~ALC/GRUAG

18. ESTIMATEO

. TOTAl PRICE

7. DO 250 REO 9. DIST STATEMENT 10. FReQUENCY 12. DATE Of FIRST SUBMISSION 14. OIST!IIBUTION REQUIRED ASREQ ASREQ DD b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESS€£ Final D SUBMISSION D•aft N/A ASREQ ASREQ flo; Repro

16. REMARKS Program Manager 1 Block 4: DID para 2. c. thru k. not required. Other pertinent information tbr Para 2.1. shall See Block 16 for be expansion of days off due to injury. This shall be the same information the Contractor email address reports on OS IIA 300 log. Contmctor format acceptable.

Alternate COR l Block 7: The Govenuncnt will accept Receiving Report through WA WF. Contractor shall Sec Block 16 for submit the Receiving Report upon final submission. email address

Block 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only. Other requests shall be referred to the contract management team, office symbol (WR-i\1 .C/GRUAU). street address (235 Byron St., Suite 19A), Robins AFB. GA 31098.

Blocks 10-13: Contractor shall submit annual updates as required.

Block 14: Procuring Ol11ccr(s} e-mail along with Integrated Product Team e-mail distro list will be provided as required. Electronic media shall be provided by CD!DVD media in Micro!\Ofi Otlie.e compatible lormat.

Program Manager: dnnicla.pctcrsonf<i)robins.af.mil

Alternate COR: david.millcr4@robins.af.mil

I

16. TOTAl 0 2 0 I

G. PREPARED BY H. DATE

''fZ::aY~

J. DATE

Daniela Peterson, Program Manager 28 Jun 2012 (2-(Jjl l.I:JIT DD FORM 1423-1 , FEB 2001 PREVIOUS EDITION MA(JE USED. Page of Pages -- --Adobe PmfeeaiOMJ 7.0

(1 Data Item) OMB No. 0704-0188

The public reporting ,burden ior this collection of 1nformat1on is estimated to average 110 hours .per respons•, irw:luding the time for rwiewll'lg i!lltruc:tiona., sean::hing exfsti~ d<Jti) !)OurU'ts, gathermg and maintaining the data needed\ and complatlng and rtviewing the collec:tion of infMmation. $@-nd comments regarding this burden •stimate or any other a$pec1 o-f ttl!s coll«tion of information, including sugguticns for re-ducing the bvrden, to the DapartJTMtnt of Dttfen-se. Executive Services Dlrector.ate !07()4.0188), Retponde-ntt $hould- be aware th4t ~ith:Jtandlng any ott'ttt ~roviaion of law, no p•rson shall be subjtct to M\y ~naltV fot faifing to comply with a colklction of tnto.rmat~on ~f rt do~s not display .a evrrftlitly vaf~d OMS -control number, JNH do not return your form to the above atganitation. Send oo'"'f'leted form to the Government lssUng Contracting Offi~t f« t:ht! ComractiPR No. lined in Bloc:k £, A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

oo4! AG- TOP TM ·-·· OTHER

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

Advisory and Assistance Services FD2060-12-32444

1. DATA ITEM NO. 2. TITI..f OF DATA ITEM 3. SUBT1TLI!

i\007 Quality Program l'lan (QPP) Contractor's Quality Control Plan

4. AUTHORITY /0~18 Acqu•~~<tkm Oocvrmmr No.) 15. CONTRACT REFeRENCE f. REQUIRING OFFICE

DI-QCIC-81722 PWS Para. 4.23. 7 WR-ALC/GRUAG

1. DO 250 REO 9. DlST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION REQUIRED ASREQ SEEBLK 16 DD b. COPitS

8. Af'P CODE B

11. AS OF DATE 13.DATEOFSUBSEOUENT a. ADDRESSEE Final SUBMISSION Df•ft N/A 15 DAYSARO ASREQ Ret Repro

16. REMARKS Program Manager 1 Block 7: W A WF ACCEJ>TOR: The Government will accept the Receiving Report through See Block 16for W A WF. Contra~.:tor shall submit Rc<.-eiving Report upon each submission. email address

Block II. 12: Contractor shall submit QPP 15 days after contract award and as changes Alternate COR 1 occur See lllock 16 for email address Block 14: The Procuring Contracting Officc:r(s) e-mail along with Integrated Product Team

~-mail distro Jist will be provided as required. Electronic media shall be provided in

MicroS<)tl Office compatible li:>rmat.

danicla.pctcrson!rlrobins.at:mil david.miller4rt:f;r()bins.at:mil

15. TOTAL 0 2 0

G. PREPARED BY H. DATE I.~OVEOBY t/)-Jk_

J.OATE

Daniela Peterson, Program Manager 28 Jun 2012 n.. :Jut ZAZ .._..,,~

DO FORM 1423-1, FEB 2001 PREVIOUS EDITION MAy OSED. Page of Pages -- --Adobot Prof..,.,;..,ai 7.0

I j i i

17. PRICE GROUP

TOTAl PRICE

1. CLEARANCE AND SAFEGUARDING

DEPARTMENT OF DEFENSE a FACILITY CLEARANCE REQUIRED CONTRACT SECURITY CLASSIFICATION SPECIFICATION Secret

(The reqwrements of !he DoD Industrial Security Manual apply

b. LI:VEL OF SAFEGUARDING REQUIRED to all security aspects of this 8frot1) None

2. THIS SPECIFICATION IS FOR: (X and complet& as applrcable) 3. THIS SPECIFICATION IS: (X 11nd complete as appHcable)

X

a. PRIME CONTRACT NUMBER

X DATE (yyyYMMDO)

a. ORIGINAL (Complet& dille In all Cll$es) 2012()703

b. SUBCONTRACT NUMBER b. REVISED I REVISION NO. DATE (YYYYMMDO)

(Supersedn all previous specs)

c. SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMOO) DATE (YYYYMMOO)

c. FINAL (Compl&fe Item 5 ill all C88e$)

4. IS THIS A FOLLOW-ON CONTRACT? L_jYES ~NO. If Yes. complete the following:

Classified material receiVed or generated under (Pifl<eding Contract Numbflr) IS traflsferred lo this follow-on contract

5. IS THIS A FINAL DO FORM 2&4? L_jYES TxJNo. If Yea. complete the following:

In response to the contractor's request dated . retention of the class~ied matenal is authOriZed lor tile pe~~od of

6. CONTRACTOR (lnc:tude Commercial and Government Enbty (CAGE) Code)

a. NAME. ADDRESS. ANO ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE (Name, Addffii, and Zip Code)

7. SUBCONTRACTOR

a NAME. ADDRESS. AND ZIP CODE b. CAGECOOE c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code)

N/A NIA NIA

8. ACTUAL PERFORMANCE

a LOCATION b. CAGE CODE c. COGNIZANT SECURITY OFFICE {Name. Address. and Zip Code) su: CONTINUATION SIIEET

9. GENERAL IOENnFtCATlON OF THIS PROCUREMENT

'Jbc WillA !'rogram Ollicc requires Contr.tct Logistics and Technical Services.

10. CONTRACTORWJU REQUIRE ACCESS TO: YES NO 11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL: YES NO o CCNMUNICAnONS SECURrl'Y (COMS!!C) INFORMATION X • f·nX~ICffV M J.'15il vnv HEF X b RESTRICTED DATA X b RECEIVE CLASSIFIED DOCUMSIITS ONL V X c CRITICAL NUClEAR 1/IEAPON DESIGN INFORMAHON X c RECEIVE AND GENERATe CLASSIFIED MATERIAL X d FORMERLY RESTRICTED DATA X d FABRICATE, MODFY, OR STORE CLASSIFIED HAROWO.RE X r- X • INTELLIGENCE INFORMATION e PERFORM SERVICES ON\. Y

{1) S•nMW~ lnfotmabon(SCIJ X -us. X (2)NooSCI X g ~M ~ ~ C'i"'N'trn X f SPECIAL ACCESS INFORI.IATION X h REQUIRE A COMSEC ACCOUW X g NATO INFORMATION X !. HAVE TEMPEST REQUIREMENTS X h f'ORF.IGN GOVERNMENT INFORMADON X j. HAllE OPERA HONS SECURITY (OPSECJ REQUIREMENTS X ! LiMITED OtSSEMINA nON INFORMATION X k BE AUTHORIZED TO USE THE DEFENSE COUFUER SERVICE X J FOR OfFICIAL LSE ONLY INFORMA'TTON X I OTHER {Specify) X k OTHER !Specify} VGSA (Robins.llurlburt. Eglin. Duke Ficld.l93 SOW/PANG)

X DO FORM 254 DEC 1999 PREVIOUS EDITION IS OBSOLETE. AdobeProiMJionll70

12. PUBLIC RELEASE. Ally Information (classitf«J orunclliS$/fled) penalnlng to thlt contrac:l IlleR not be reteased I« public disaeminalion except as provided by the Industrial Securlly MIRIIll or unleu ~ hal bef!n .pproved for public reieaH by apllf'Oil'late U.S. Government authority. Proposed public reteuet thall be submitted for approval Pl1« to release D Oirecl [2[] Through (~)

78ABWIPA

620 North Street, Rm 21 S, Suite 230 Robins AFB, GA 31098 to the Oltectonne for Freedom c1lntonnlltion and Security Review, OffiCe til the Asllatant Secretary til Oetanse (P\ibllc: Allainl)" fat ravlew.

"'n the case ot non-DoD User Agencies, r~ests for dlselaeure lhal be submitted to that agency.

13. SECURITY GUIDANCE. The Hcurily Clenlllcatlon guidance needed fat thiS etuaifled eiiCI'I is Identified below. If any dlfflculty Ia enoountered In applying this guld!Wice or It any 041111' contr1bUting f8l:tcr lndic:etea a 1\Hd for changes In 1hi& guldllnoe, the cantrat:lQr lsiUiholized and ~to provide~ changes; to c:halqe the guidance at the cleMiflcatlon 8Migned to any infocm81ion or lftlllerial fumllhed or genenlled under this contract; and to tubmlany questions lor lntetprlllaticn of this guidance to the olrldal identified below. Pending final dec:lllon, the ln!CIImallon involved 111811 be handled and ~acted Ill the higheat level ot clasaiflcatlon assigned or reccmmended. (F/1 In at app!Oplfale fOr the clu.iffed effort. Altech. or lbtWIIIt under aepara,. COrtetPOndence, any documentllguideslextracts tWfHenced ltete/n. Add adrlilionM ~ges as needed to provide complete guidance J

USAF Program Manager:

-'''\ D1

DANIELA PETERSON

AFLCMCIWIUAG

235 Byron Street, Suite 19A Robins AFB, GA 31098-1622 478-222-8638 or DSN 472-8638 daniela.peterson@robins.af.mil

USAf Security Specialist

235 Byron Street, Suite 19A

Robins AFB, GA 31098-1622 478-222-5149 or DSN 472-5149 lera.monroe@robins.af.mil

USAF Servicing Security Activity:

MEL VESE HARRIS

78ABW/IP

250 Peacekeeper Way Robins AFB, GA 31098-1808 478-222-1971 or DSN 472-1977 mclvese.harris@robins.af.mil

14. ADOmONAL SECURITY REQUII'tEMEHTS. Requlrwnenta, in eddftion to ISM requirwnenla, .. establlthed tor this contnlcl. No (If Ytt. ldenl!fy !he patfln•nt contractulll dausn In I1HI contract do<:um.nt Itself. or provlda an appropnat. slllement which idantifftla I1HI eddi n ~u.tnenll. Provide a copy Of I1HI teqUIIMietll$10 I1HI cognizant Sfleurily oM~. UN llem 13 if add/fiDnel $p8C1 Ia naedad.)

Provide the intbnnation requested by the Notification of Government Security Activity and Visitor Group Security Agreement Clause, AfFARS 5352.204-9000, to the Servicing Security Activity (SSA) address where the work will be performed. Refer to the contract docwnent for this clause.

15. INSPECTIONS. Elements of thia contract .. outllde the irlaf>ection reaponalbillty of the cogniZant MCUitty otfice. X Yet No (ff Yea. explain end Identify apaci/fe antat or llemema CltVtd out and fhf ~WIMty tei(JOIIS/bllt for /MpiJCijOM. II• /tam 13/ledd/fiollei'IJIICft I$ naaded.J

Industrial Security Reviews for long tenn visitor groups will be conducted by the SSA while operating on an Air Force installation. The contractor will comply with the visitor groUp security agreement provided by the USAF Program/Project Manager at the performance location.

16. CERTIFICATION AND SIGNATURE. Security requll'lll1'alts steted herein are ~plebt and adequate for Nfllguarcllng the c:lasalfled Information to M reiNMd or gsnem.d under this claalfled effort. All quMtlone shall be m.rred to the official II8IMCI below.

a. TYPED NAME OF CERTIFYING OFFICIAL b. TITLE c. TELEPHONE (ltlduda Allie Coda)

BECKIE KING Contracting Officer 478-926-2746

d. ADDRESS (lnc/Uda Zip Codt}

AFLCMCIWIKAA a CONTR!ICTOR

235 Byron Street, Suite 19A b. SUIICONTRACTOR

~:~~~S~~IGNA~·~A~~~UR~~~A __ 3_109 __ 8 ________________________________ -r~-i:~~~:~~~~:~~~~~~~~~noN

e. AOMINISTRA TillE CONTRACTIHG OFFICER t OTHERS AS NECESSARY '~ia-n ~

Ref Item lOj: FOUO information provided under this contract shall be safeguarded as specified in DoOM 5200.01-V4, DoD Information Security Program: Controlled Unclassified Information.

Ref Itemlla: Contract performance is restricted to locations listed in government locations listed above for item 8a. Using activity will provide security classification guidance for performance of this contract. Contractor will receive classified documents for reference only;

however, if any classified information is generated in performance of this contract, it shall be derivatively classified and marked consistent with the source material or be governed by the following applicable Security Classification Guides(SCGs) :

HC-130 MC-130P (U) dated 18 November 2011 MC-130E (U) dated 1 July 2011 MC130-H (U) dated 1 July 2011 AC-130U (U) dated 22 July 2011 AC-130H (U) dated 22 June 2011 EC-130J (U) dated 21 July 2011

* MC-130W (U) dated l July 2011

* Precision Strike Package (PSP) Program dated 4 Feb 20 l 0 (*Applicable to the AC-130W Stinger II Aircraft-formally the MC-l30W Combat Spear Aircraft)

Ref Itemllj: Contractor personnel will participate in the OPSEC program locally administered by the AF activity.

Ref Item 17f: Ensure certification and signatures are completed by contracting officer and distribution is made to the following organizations:

AFLCMC/WIUA

235 Byron Street, Suite 19A Robins AFB, GA 31 098 478-222-5149 or DSN 472

193 SFS/S5

81 Constellation Court Middletown, PA 17057 717-945-2458 or DSN 423

Philadelphia Field Office (IOFNP) Defense Security Service 2 International Plaza Suite 51 0 Philadelphia, P A 19113-1514 Main: 610-595-1870

78 ABW/IPD

250 Peacekeeper Way Robins AFB, GA 31098 478-222-1977 or DSN 472

Defense Security Service (IOFSA) 1899 Powers Ferry Road, Suite 330 Atlanta, GA 30339 770-635-0455

DO FORM 254 CONTINUATION SHEET

Ref. Sa: Contract performance will occur at the following locations:

AFLCMC/WIUNWIUL (Bldg 300) 235 Byron Street, Suite 19A Robins AFB, GA 31 098-1670

AFLCMC/WIUAB

235 Byron Street, Suite 19 (Bldg 20036) Robins AFB, GA 31098-1670 Telephone 478-327-2594, (DSN 497)

AFLCMC/EBHA (Armament) (Bldg 301) 460 Richard Ray Blvd, Suite 200 Robins AFB, GA 31098

HQ Air Force Special Operations Command (Bldg 1) 100 Bartley Street Hurlburt Field, FL 32544 Telephone 850-884-4835(DSN 579)

1st Special Operations Maintenance Squadron (1st SOMXS/MXM) I 03 South Magnolia Street (Bldg 422) Eglin AFB, FL 32542 Telephone 850-882-2135 (DSN 872)

801 st Special Operations Aircraft Maintenance Squadron (SOAMXS, 15th Aircraft Maintenance Unit) 911 Tully St. Bldg 90029 Hurlburt Field, FL 32544

193 Special Operations Wing (SOW) Building 101 Olmsted Blvd Middletown, P A 17057

AFLCMC/WIUAA (Geographically Separated Unit) c/o Boeing Company 626 Anchors Street NW Fort Walton Beach, FL 32548

919 MXG/MXQ

Spectre Road (Bldg 3076, Room 12) Eglin AFB, Field 3, FL 32542 Telephone 850-883-6418 (DSN 875)