CDRLS.pdf
PDF 533 KB Posted
- Attached to
- Repair of the TH-1H Servo Con Altimeter
- Solicitation number
- FA852427RB001
About this file
This document is a Contract Data Requirements List (CDRL) using DD Form 1423-1 for contract FD20602600562, covering the TH-1H/8047/10NVG-5V system under Air Force contract management at 411 SCMS/GULBA. The CDRL specifies seven data items that the contractor must deliver throughout the contract performance periods (Base Year plus four option periods).
The required data items include: (1) Government Property Inventory Report submitted annually within seven calendar days of each option/ordering period end in Microsoft Excel format; (2) Item Unique Identification (IUID) Marking Plan due within 30 calendar days after contract award in PDF format, with quarterly updates as needed; (3) IUID Marking Activity and Verification Report submitted quarterly in PDF format with 10 working days for government acceptance; (4) Commercial Asset Visibility Air Force (CAV AF) End Item Report submitted daily via the CAV AF website within 24 hours of supply or maintenance actions, requiring contractor DOD PKI certification; (5) Counterfeit Prevention Plan submitted within 30 workdays after award with quarterly updates, submitted via email in PDF format; (6) Contract Depot Maintenance (CDM) Monthly Production Report submitted no later than the 10th calendar day after month-end in Microsoft Office or PDF format; and (7) Accident Incident Report submitted within 24 hours after accident/incident occurrence per AFI 91-204 and 91-207. All deliverables require electronic submission to designated Program Manager and Engineer contacts at specified Air Force email addresses, with approval codes "A" (public release) or "C" (U.S. Government agencies and contractors only). The CDRL was prepared by Leah C. Delery on 18 September 2026 and approved by Lindsay J. Palumbo on 17 September 2026.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CAV AF REPORTING.pdf | ||
| PERFORMANCE WORK STATEMENT.pdf | ||
| PKGRQMT_REPORT.pdf | ||
| TRNSPDATA_REPORT.pdf | ||
| GFP ATTACHMENT.pdf | ||
| OMBUDSMAN.pdf | ||
| Solicitation - FA852427RB001.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CONTRACT DATA REQUIREMENTS LIST Form Approved OMB No. 0704-0188(1 Data Item)
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 Department of Defense, Executive Services Directorate (0704-0188).
Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
TH-1H/8047/10NVG-5V
E. CONTRACT / PR NO.
FD20602600562
1. DATA ITEM NO.
A/B/C/D/E A001
2. TITLE OF DATA ITEM
Government Property Inventory Report
3. SUBTITLE
Government Property Inventory Report
4. AUTHORITY
DI-MGMT-80441D
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS Para. 3.6
6. REQUIRING OFFICE
411 SCMS/GULBA
7. DD 250 REQ
LT
8. APP CODE
A
9. DIST STATEMENT
REQUIRED
A
10. FREQUENCY
ANNLY
11. AS OF DATE
See Block 16
12. DATE OF FIRST
SUBMISSION
See Block 16
13. DATE OF SUBSEQUENT
SUBMISSION
See Block 16
a. ADDRESSEE
Draft Final
ReproReg
b. COPIES
14. DISTRIBUTION
16 SEP 2026DATE:
16. REMARKS
NAME: Delery, Leah C
CLIN Exhibit Data Item No. Performance Period
BLK 4: The data item description (DID) contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract. See Data Item Description at http://quicksearch.dla.mil/ for content requirements and most current version.
BLK 7: Enter the applicable code as listed in DOD 5010.12-M, Chapter 3. (Enter LT for Letter of Transmittal if not separately priced or DD if separately priced). WAWF E-DD FORM 250 shall be required for separately priced data.
EDD FORM 250 shall be submitted to FA8524 Program Manager (PM Micah Tapp micah.tapp.2@us.af.mil/ and Supply Planner (Sharon Quinn) sharon.quinn@us.af.mil.
for acceptance.
BLK 8: Approval (written) is not required. However, the data item will be reviewed and accepted/rejected, based on its conforming to the requirements of the DID, and within the review time specified in Block 16, items 10-13.
BLK 9: "A" Approved for Public Release; distribution is unlimited.
BLKS 10-13: The annual physical inventory report shall be provided within seven (7) calendar days of the end of each option/ordering period for the contract. The data is representative of the Contractor's Internal Property Control System and shall be current as of the last day of the option/ordering reporting period. If requested outside of an annual cadence, the data shall be current as of the date requested.
BLK 14: EMAIL electronic Annual Physical Inventory Report to the Supply Planner (SP) and Program Manager (PM).
Points of Contact will be provided to the Contractor at Contract Award. Submit digital copy in Microsoft Office Excel format for all reports.
COORDINATORS:
411SCMS.PMS@us.af.mil 0 1 0 micah.tapp.2@us.af.mil 0 1 0
0 2 015. TOTAL
G. PREPARED BY
Delery, Leah C
411 SCMS / GULBB
478-497-5392
H. DATE
18 SEP 2026
I. APPROVED BY
//ELECTRONICALLY SIGNED//
Palumbo, Lindsay J
411 SCMS / GULBA 478-222-3616 / 472-3616
J. DATE
17-SEP-26
Page 1 of 7DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 18 Sep 2026
PREVIOUS EDITION MAY BE USED.
000X/100X/200X/300X/400X A/B/C/D/E
F. CONTRACTOR
TBD
000X A A001 Base Year Period 100X B B001 Ordering Period 1 200X C C001 Ordering Period 2 300X D D001 Ordering Period 3 400X E E001 Ordering Period 4
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
TH-1H/8047/10NVG-5V
E. CONTRACT / PR NO.
FD20602600562
1. DATA ITEM NO.
A/B/C/D/E A002
2. TITLE OF DATA ITEM
(IUID) Marking Plan
3. SUBTITLE
Item Unique Identification
4. AUTHORITY
DI-MGMT-81803A
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS Para. 4.4.2.3
6. REQUIRING OFFICE
411 SCMS/GULBA
7. DD 250 REQ
LT
8. APP CODE
See Block 16
9. DIST STATEMENT
REQUIRED
C
10. FREQUENCY
QRTLY
11. AS OF DATE
See Block 16
12. DATE OF FIRST
SUBMISSION
See Block 16
13. DATE OF SUBSEQUENT
SUBMISSION
See Block 16
a. ADDRESSEE
Draft Final
ReproReg
b. COPIES
14. DISTRIBUTION
15 SEP 2026DATE:
16. REMARKS
NAME: Delery, Leah C
CLIN Exhibit Data Item No. Performance Period
BLK 9: "C" Distribution authorized to U.S. Government Agencies and their contractors (Administrative or Operational Use, 28 April 16) Other requests shall be referred to the contract management team, AFSCC/PZAAA 460 Richard Ray BLvd, Suite 221, Robins AFB, GA 31098
BLKS 10-13: The contractor shall submit a complete IUID Marking Plan within 30 calendar days after contract award.
The Government will review and determine acceptance or rejection and notify contractor within 10 calendar days of receipt. If rejected, the contractor shall have 10 calendar days to correct any error and return a corrected IUID Marking Plan to the Government for review.
BLK 7, 14: Forward one electronic copy in PDF format to the following email address:
Program Manager: Micah Tapp (E-mail: micah.tapp.2@us.af.mil) Engineer: Alissa Johnson (E-mail: alissa.johnson.2@us.af.mil)
COORDINATORS:
Email: 411 SCMS/GULBA Program Manager (PM)/COR Provided on Contract Award
1 1 0
Email: AFLCMC/WIUEE Engineer Alissa Johnson at alissa.johnson.2@us.af.mil
1 1 0
Email: AFSC/PZAAA Contracting Officer (PCO) Provided on Contract Award
0 1 0
Email: DCMA/ACO 0 1 0
2 4 015. TOTAL
G. PREPARED BY
Delery, Leah C
411 SCMS / GULBB
478-497-5392
H. DATE
18 SEP 2026
I. APPROVED BY
//ELECTRONICALLY SIGNED//
Palumbo, Lindsay J
411 SCMS / GULBA 478-222-3616 / 472-3616
J. DATE
17-SEP-26
Page 2 of 7DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 18 Sep 2026
PREVIOUS EDITION MAY BE USED.
000X/100X/200X/300X/400X A/B/C/D/E
F. CONTRACTOR
TBD
000X A A001 Base Year Period 100X B B001 Ordering Period 1 200X C C001 Ordering Period 2
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
TH-1H/8047/10NVG-5V
E. CONTRACT / PR NO.
FD20602600562
1. DATA ITEM NO.
A/B/C/D/E A003
2. TITLE OF DATA ITEM
Item Unique Identification (IUID) Marking Activity, Validation and Verification Report
3. SUBTITLE
Item Unique Identification
4. AUTHORITY
DI-MGMT-81804A
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS Para. 4.4.2.4
6. REQUIRING OFFICE
411 SCMS/GULBA
7. DD 250 REQ
LT
8. APP CODE
See Block 16
9. DIST STATEMENT
REQUIRED
C
10. FREQUENCY
QRTLY
11. AS OF DATE
See Block 16
12. DATE OF FIRST
SUBMISSION
See Block 16
13. DATE OF SUBSEQUENT
SUBMISSION
See Block 16
a. ADDRESSEE
Draft Final
ReproReg
b. COPIES
14. DISTRIBUTION
16. REMARKS
Delery, Leah CNAME: 16 SEP 2026DATE:
CLIN Exhibit Data Item No. Performance Period
BLK 4: IUID Marking Activity and Verification Report can be combined with the monthly status report.
BLK 7: Applicable code as listed in DOD 5010.12-M, Chapter 3. (LT for Letter of Transmittal if not separately priced or DD if separately priced) WAWF E-DD FORM 250 shall be required for separately priced data. E-DD FORM 250 shall be submitted to FA8524 (PM EMAIL ADDRESS) for acceptance.
BLK 8: Approval (written) is not required. However, the data item will be reviewed and accepted/rejected based on its conforming to the requirements of the DID, and within the review time specified in Block 16, items 10-12.
BLK 9: "C" Distribution authorized to U.S. Government Agencies and their contractors (Administrative or Operational Use,28 April 16) Other requests shall be referred to the contract management team, AFSCC/PZAAA 460 Richard Ray BLVD, Suite 221, Robins AFB, GA 31098
BLKS 10-13: Contractor shall submit an IUID Marking Activity and Verification Report to the Engineer AFLCMC/WIUEE, every three months (quarterly). Written Government acceptance/comments/rejection will be within 10 working days after receipt of Plan from the Contractor. Contractor final submission shall be submitted within 10 working days of receiving Government comments. Acceptance by the Government is required prior to formal distribution.
BLK 14: Forward one electronic copy in PDF format to the following email address:
Procuring Contract Officer (PCO) Teresa Smith (E-mail teresa.smith.16@us.af.mil) Program Manager (PM) Micah Tapp (E-mail micah.tapp.2@us.af.mil) Engineer Alissa Johnson (E-mail alissa.johnson.2@us.af.mil)
COORDINATORS:
Email: 411 SCMS/GULBA Program Manager (PM) PM email provided on Contract Award
1 1 0
Email: AFLCMC/WIUEE Engineer Robert Guest at alissa.johnson.2@us.af.mil
1 1 0
Email: AFSC/PZAAA Contracting Officer (PCO) Provided on Contract Award
0 1 0
Email: DCMA/ACO 0 1 0
2 4 015. TOTAL
G. PREPARED BY
Delery, Leah C
411 SCMS / GULBB
478-497-5392
H. DATE
18 SEP 2026
I. APPROVED BY
//ELECTRONICALLY SIGNED//
Palumbo, Lindsay J
411 SCMS / GULBA 478-222-3616 / 472-3616
J. DATE
17-SEP-26
Page 3 of 7DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 18 Sep 2026
PREVIOUS EDITION MAY BE USED.
000X/100X/200X/300X/400X A/B/C/D/E
F. CONTRACTOR
TBD
000X A A001 Base Year Period 100X B B001 Ordering Period 1 200X C C001 Ordering Period 2
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
TH-1H/8047/10NVG-5V
E. CONTRACT / PR NO.
FD20602600562
1. DATA ITEM NO.
A/B/C/D/E A004
2. TITLE OF DATA ITEM
Commercial Asset Visibility Air Force (CAV AF) End Item Report
3. SUBTITLE
CAV AF
4. AUTHORITY
DI-MGMT-81838
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS Para. 4.4.4
6. REQUIRING OFFICE
411 SCMS/GULBA
7. DD 250 REQ
LT
8. APP CODE
N/A
9. DIST STATEMENT
REQUIRED
A
10. FREQUENCY
See Block 16
11. AS OF DATE
See Block 16
12. DATE OF FIRST
SUBMISSION
See Block 16
13. DATE OF SUBSEQUENT
SUBMISSION
See Block 16
a. ADDRESSEE
Draft Final
ReproReg
b. COPIES
14. DISTRIBUTION
16 SEP 2026DATE:
16. REMARKS
NAME: Delery, Leah C
CLIN Exhibit Data Item No. Performance Period
BLK 1. The contractor shall report End Item transactional data through electronic submission in CAV AF using the CAV AF web site or CICA XML IAW the referenced DID IAW and/or CAV AF CFM Reporting Requirements. This information will be accessed by the program office SP and by 420 SCMS/GUNAB-Robins in order to ascertain production status.
BLK 2. Transactions and data will be submitted by the contractor daily IAW CAV AF User Guide, Version 8.0.1 or higher. The Contractor shall obtain a valid DOD PKI certificate to log into CAV AF. Each user shall be required to have an: Identity Certificate only; an encryption certificate is not required.
BLK 3. Training will be provided by 420 SCMS/GUNAB-Robins, (478) 327-6603 or 6602 if required and a request must be initiated by the CAV Reporter BLK 4. This DD Form 1423-1 applies to Contractor Furnished Materiel (CFM) type contracts.
BLK 7: Enter the applicable code as listed in DOD 5010.12-M, Chapter 3. (Enter LT for Letter of Transmittal if not separately priced or DD if separately priced.) E-DD FORM 250 shall be submitted to DCMA for acceptance.
BLK 10: a. Contractor reporting requirements to CAV AF shall be accomplished daily and/or within 24 hours of a supply or maintenance action occurrence IAW Contractor Users Guide.
b. The method of communication from the contractor to the funding base will be mechanized using the CAV AF Online web site IAW CAV AF Contractor Users Guide.
BLK 11: Data shall be current within 24 hours of last End Item maintenance occurrence.
BLK 12: Date of first submission shall be within 24 hours following a supply or maintenance transaction after the contract award date and government training as specified in IAW CAV AF Users Guide.
BLK 13: Same as remarks regarding Block 10 above.
COORDINATORS:
Email: 411 SCMS/GULBA Program Manager (PM) PM email provided on Contract Award
0 1 0
Email: 411 SCMS/PMS Workflow @ 411SCMS.PMS@us.af.mil if PMS email is not provided
0 1 0
0 2 015. TOTAL
G. PREPARED BY
Delery, Leah C
411 SCMS / GULBB
478-497-5392
H. DATE
18 SEP 2026
I. APPROVED BY
//ELECTRONICALLY SIGNED//
Palumbo, Lindsay J
411 SCMS / GULBA 478-222-3616 / 472-3616
J. DATE
17-SEP-26
Page 4 of 7DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 18 Sep 2026
PREVIOUS EDITION MAY BE USED.
000X/100X/200X/300X/400X A/B/C/D/E
F. CONTRACTOR
TBD
000X A A001 Base Year Period 100X B B001 Ordering Period 1 200X C C001 Ordering Period 2
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
TH-1H/8047/10NVG-5V
E. CONTRACT / PR NO.
FD20602600562
1. DATA ITEM NO.
A/B/C/D/E A005
2. TITLE OF DATA ITEM
Counterfeit Prevention Plan
3. SUBTITLE
Counterfeit Prevention Plan
4. AUTHORITY
DI-MISC-81832
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS Para. 4.4.6
6. REQUIRING OFFICE
411 SCMS/GULBA
7. DD 250 REQ
LT
8. APP CODE
A
9. DIST STATEMENT
REQUIRED
C
10. FREQUENCY
See Block 16
11. AS OF DATE
See Block 16
12. DATE OF FIRST
SUBMISSION
See Block 16
13. DATE OF SUBSEQUENT
SUBMISSION
See Block 16
a. ADDRESSEE
Draft Final
ReproReg
b. COPIES
14. DISTRIBUTION
16 SEP 2026DATE:
16. REMARKS
NAME: Delery, Leah C
CLIN Exhibit Data Item No. Performance Period
BLK 4: The Data Item Description contains the format and content preparation instructions for the data product generated by the specific and discrete task requirements delineated in the statement of work. See Data Item Description at http://quicksearch.dla.mil/ for content requirements and most current version.
BLK 7: The Government will accept the receiving report through WAWF. The contractor shall submit the receiving report upon final submission to DODAAC FA8524, Attention: micah.tapp.2@us.af.mil (Program Manager) to account for data previously submitted by letters of transmittal. The Government will approve/disapprove within 30 calendar days after receipt.
BLK 9: "B" Distribution authorized to U.S. Government agencies only (Administrative or Operational use) (28 April 16). Other requests shall be referred to the contract management team, AFSC/PZAAA, 460 Richard Ray Blvd, Suite 221, Robins AFB, GA 31098.
BLKS 10-13: Draft Counterfeit Prevention Plan shall be submitted electronically within 30 workdays after contract award. Contractor shall provide quarterly updates as necessary until final at completion of program. The Government will have 15 workdays to approve, submit comments, or disapprove all submissions. The contractor shall have 15 workdays to resubmit report if changes were deemed necessary by the Government.
BLK 14: EMAIL electronic Counterfeit Prevention Plan to the following email address:
Procuring Contract Officer (PCO) AFSC/PZAAA: Teresa Smith (E-mail: teresa smith.16@us.af.mil) Program Manager: Micah Tapp (E-mail: micah.tapp.2@us.af.mil) Engineer: Alissa Johnson (E-mail: alissa.johnson.2@us.af.mil)
Email: 411 SCMS/GULBA Program Manager (PM) PM email provided on Contract Award
1 1 0
Email: AFLCMC/WIUEE Engineer Robert Guest at alissa.johnson.2@us.af.mil
1 1 0
Email: AFSC/PZAAA Contracting Officer (PCO) Provided on Contract Award
0 1 0
Email: DCMA/ACO 0 1 0
2 4 015. TOTAL
G. PREPARED BY
Delery, Leah C
411 SCMS / GULBB
478-497-5392
H. DATE
18 SEP 2026
I. APPROVED BY
//ELECTRONICALLY SIGNED//
Palumbo, Lindsay J
411 SCMS / GULBA 478-222-3616 / 472-3616
J. DATE
17-SEP-26
Page 5 of 7DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 18 Sep 2026
PREVIOUS EDITION MAY BE USED.
000X/100X/200X/300X/400X A/B/C/D/E
F. CONTRACTOR
TBD
000X A A001 Base Year Period 100X B B001 Ordering Period 1 200X C C001 Ordering Period 2
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
TH-1H/8047/10NVG-5V
E. CONTRACT / PR NO.
FD20602600562
1. DATA ITEM NO.
A/B/C/D/E A006
2. TITLE OF DATA ITEM
Contract Depot Maintenance (CDM) Monthly Production Report
3. SUBTITLE
Production Report
4. AUTHORITY
DI-PSSS-81995A
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS Para.4.8
6. REQUIRING OFFICE
411 SCMS/GULBA
7. DD 250 REQ
LT
8. APP CODE
See Block 16
9. DIST STATEMENT
REQUIRED
A
10. FREQUENCY
See Block 16
11. AS OF DATE
See Block 16
12. DATE OF FIRST
SUBMISSION
See Block 16
13. DATE OF SUBSEQUENT
SUBMISSION
See Block 16
a. ADDRESSEE
Draft Final
ReproReg
b. COPIES
14. DISTRIBUTION
16. REMARKS
Delery, Leah CNAME: 16 SEP 2026DATE:
CLIN Exhibit Data Item No. Performance Period
BLK 4: The Data Item Description (DID) contains the format, content and preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract. This report shall be provided in the format of Table 1. See DID for Table 1 and content requirement explanations at http://quicksearch.dla.mil/ for content requirements and most current version.
BLK 7: WAWF E-DD FORM 250 shall be required for separately priced data. E-DD FORM 250 shall be submitted to FA8524 (micah.tapp.2@us.af.mil) for acceptance.
BLK 8: Approval (written) is not required. However, the data item will be reviewed and accepted/rejected, based on its conforming to the requirements of the DID, and within the review time specified in Block 16.
BLK 9: "A" Approved for Public Release; distribution is unlimited.
BLKS 10- 13: Report shall be submitted NLT the 10th calendar day after the end of the month being reported.
BLK 14: EMAIL electronic Contract Depot Maintenance Production Report to the Production Management Specialist (PMS) and Program Manager (PM). Points of Contact will be provided to the Contractor at Contract Award. Submit digital copy in a Microsoft Office compatible format or Adobe Portable Document Format for all reports.
COORDINATORS:
411 SCMS/GULBA Program Manager (PM) PM email provided on Contract Award
0 1 0
Email: 411 SCMS/PMS Workflow:
411SCMS.PMS@us.af.mil
0 1 0
0 2 015. TOTAL
G. PREPARED BY
Delery, Leah C
411 SCMS / GULBB
478-497-5392
H. DATE
18 SEP 2026
I. APPROVED BY
//ELECTRONICALLY SIGNED//
Palumbo, Lindsay J
411 SCMS / GULBA 478-222-3616 / 472-3616
J. DATE
17-SEP-26
Page 6 of 7DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 18 Sep 2026
PREVIOUS EDITION MAY BE USED.
000X/100X/200X/300X/400X A/B/C/D/E
F. CONTRACTOR
TBD
000X A A001 Base Year Period 100X B B001 Ordering Period 1 200X C C001 Ordering Period 2
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
TH-1H/8047/10NVG-5V
E. CONTRACT / PR NO.
FD20602600562
1. DATA ITEM NO.
A/B/C/D/E A007
2. TITLE OF DATA ITEM
Accident Incident Report
3. SUBTITLE
Accident Incident Report
4. AUTHORITY
DI-SAFT-81563
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS Para. 5.5.2
6. REQUIRING OFFICE
411 SCMS/GULBA
7. DD 250 REQ
LT
8. APP CODE
N/A
9. DIST STATEMENT
REQUIRED
B
10. FREQUENCY
See Block 16
11. AS OF DATE
See Block 16
12. DATE OF FIRST
SUBMISSION
See Block 16
13. DATE OF SUBSEQUENT
SUBMISSION
See Block 16
a. ADDRESSEE
Draft Final
ReproReg
b. COPIES
14. DISTRIBUTION
16 SEP 2026DATE:
16. REMARKS
NAME: Delery, Leah C
CLIN Exhibit Data Item No. Performance Period
NOTE: Changes to office symbols and/or e-mail addresses, when necessary, shall be made by letter through the Government CO/ACO without further revision to this CDRL.
BLK 10: IAW AFI 91-204, if damage occurs BLK 11: Once assets have been received after contract award BLK 12: 24 hours after accident/incident BLK 13: As needed, IAW AFI 91-207 Program Manager: Micah Tapp at micah.tapp.2@us.af.mil ENG: Alissa Johnson at alissa.johnson.2@us.af.mil
COORDINATORS:
ABW/SE MIDHAP
REPORTING
78abw.se.mishaps@us.af.mil
0 1 0
CONTRACT OFFICER
REPRESENTATIVE (COR)
micah.tapp.2@us.af.mil
1 1 0
Procurement Contract Office teresa.smith.16@us.af.mil
0 1 0
1 3 015. TOTAL
G. PREPARED BY
Delery, Leah C
411 SCMS / GULBB
478-497-5392
H. DATE
18 SEP 2026
I. APPROVED BY
//ELECTRONICALLY SIGNED//
Palumbo, Lindsay J
411 SCMS / GULBA 478-222-3616 / 472-3616
J. DATE
17-SEP-26
Page 7 of 7DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 18 Sep 2026
PREVIOUS EDITION MAY BE USED.
000X/100X/200X/300X/400X A/B/C/D/E
F. CONTRACTOR
TBD
000X A A001 Base Year Period 100X B B001 Ordering Period 1 200X C C001 Ordering Period 2
File details come from the government source that posted it. Updated .