E007.pdf

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

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding thus burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract PR No. listed in Block E.

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

0004BH E TDP TM OTHER NDTI

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

Ground Power Modernization FD2060-21-31511

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

GROUP

E007 Test/Inspection Report 144 kW ULB First Connect Test Report

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

TOTAL PRICE

DI-NDTI-80809B NOT 2 SOW para 3.6.2.3.1.1.3 AFLCMC/WNZ-SEV

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

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

DD One Time See BLK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRAFT FINAL

N/A N/A N/A Reg Repro

16. REMARKS AFLCMC/ WNZ-

SEV 0 1 0

BLK 7: iRAPT shall be utilized.

BLK 9: DISTRIBUTION STATEMENT D: Distribution authorized to the Department of Defense (DoD) and U.S. DoD Contractors only; Critical Technology; Export Controlled; 08 July 2021. Other requests shall be referred to AFLCMC/WNZ.

BLKs 10, 12: The contractor shall deliver the test report no later than 10 days following the conclusion of testing cited in SOW paragraph 3.6.2.3.1.1.3 or not later than 400 days after receipt of order, whichever comes first. The Government will have 20 days after receipt of the test report to approve or disapprove. The contractor shall have 10 days to incorporate Government comments and redeliver the test report.

BLK 14: Documents shall be provided via electronic media utilizing standard Microsoft Office applications and submitted via email to the points of contact (POC) actual name, phone, and email provided by the Procuring activity at the time of contract award:

Support Equipment & Vehicles Division

ATTN: AFLCMC/WNZ-SEV

235 Byron Street, Suite 19A Robins AFB GA 31098-1813

Notification of submission shall be provided to the PCO via e-mail.

Support Equipment & Vehicles Division

ATTN: AFLCMC/WNK

235 Byron Street, Suite 19A Robins AFB GA 31098-1813

AFLCMC/WNK 0 1 0

15. Total 0 2 0

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

Relious Grant 07/26/2021

DD FORM 1423-1, Feb 2001 Previous editions are obsolete Page of Pages

9/02/2021

See BLK 16