CDRLS_A001_THRU_A011.pdf
PDF 154 KB Posted
- Attached to
- Repair of AN/APN-224 Radar Sytem components
- Solicitation number
- FA8539-18-R-0005
About this file
DD Form 1423 (A001 - A011)
View the file
Other files
| File | Type | Posted |
|---|---|---|
| FA853918R0005_______0001.pdf | ||
| FA853918R0005.pdf | ||
| PWS_17_00396_V2.pdf | ||
| AFMC_FORM_158_REPORT.pdf | ||
| QASP_17_00396.pdf | ||
| GFP_ATTACHMENT.pdf | ||
| DD_FORM_1653_TRNSPDATA_REPORT.pdf |
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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
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A001
2. TITLE OF DATA ITEM
Status of Government Furnished Equipment (GFE) Report
3. SUBTITLE
GFE
4. AUTHORITY
DI-MGMT-80269
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 3.3
6. REQUIRING OFFICE
407 scms/gulb
7. DD 250 REQ
LT
8. APP CODE
A
9. DIST STATEMENT
REQUIRED
D
10. FREQUENCY
ANNLY
11. AS OF DATE
SEE RMKS
12. DATE OF FIRST
SUBMISSION
SEE RMKS
13. DATE OF SUBSEQUENT
SUBMISSION
SEE RMKS
a. ADDRESSEE
Draft Final
ReproReg
b. COPIES
14. DISTRIBUTION
16. REMARKS
Edge, Russ ANAME: 16 OCT 2017DATE:
Block 4: Contractor format acceptable on electronic media. Data Item to be used as a guide for content.
Block 7: Submit final with DD Form 250 to account for all previously submitted via WAWF for acceptance under DODAAC: FA8539.
BLK 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative and Operational use, 31 December 2014. Other requests for this document shall be referred to the Program Manager Russ Edge, 409 SCMS/GULB
Block 10, 11, 12, 13: As required. The government will have 30 calender days to review and provide comments, subsequently the contractor will have 60 calender days to correct and resubmit.
Block 14: Submissions shall be IAW CDRL instructions and PWS 3.3
COORDINATORS:
407 SCMS/GULB
235 Bryon Street Suite 19A 31098-1813 Attn: Russ Edge russ.edge@us.af.mil
0 1 0
0 1 015. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
Page 1 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017
PREVIOUS EDITION MAY BE USED.
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A002
2. TITLE OF DATA ITEM
Status Reports
3. SUBTITLE
Status Reports
4. AUTHORITY
DI-MGMT-80368A/T
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 4.3.1.6
6. REQUIRING OFFICE
407 SCMS/GULB
7. DD 250 REQ
LT
8. APP CODE
See Block 16
9. DIST STATEMENT
REQUIRED
D
10. FREQUENCY
MTHLY
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
Edge, Russ ANAME: 16 OCT 2017DATE:
Block 4: Contractor format acceptable.
BLK 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative and Operational use, 31 December 2014. Other requests for this document shall be referred to the Program Manager Russ Edge, 409 SCMS/GULB Block 10, 11, 12, 13: Monthly submissions are required for contract. First submittal shall be due 180 days after receipt of order. Subsequent deliveries shall be complete ten calendar days after the beginning of each month and shall cover the activities of the previous month.
Report is due each month for the life of the contract.
Block 14: Submissions shall be IAW CDRL instructions, PWS 5.9, and addressed to 407 SCMS designated focal points below.
Email addresses:
russ.edge@us.af.mil yolanda.burnett@us.af.mil jonathan.martin.21@us.af.mil
COORDINATORS:
407 SCMS/GULB
235 Byron St. Suite 19A Robins AFB, GA 31098-1813 Attn: Russ Edge
0 1 0
0 1 015. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
Page 2 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A003
2. TITLE OF DATA ITEM
Engineering Change Proposal
3. SUBTITLE
ECP
4. AUTHORITY
DI-SESS-80639D
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 4.3.1.9
6. REQUIRING OFFICE
407 SCMS/GULB
7. DD 250 REQ
LT
8. APP CODE
A
9. DIST STATEMENT
REQUIRED
D
10. FREQUENCY
ASREQ
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
Edge, Russ ANAME: 16 OCT 2017DATE:
Block 4: Contractor format acceptable.
Block 12: Submit draft 15 days prior to formal submission of an ECP.
Block 14: Submissions shall be IAW CDRL instructions and PWS 4.3.1.9
COORDINATORS:
407 SCMS/GULB
235 Byron St. Suite 19A Robins AFB, GA 31098-1813 Attn: Long Nguyen, long.nguyen.6@us.af.mil
1 1 0
1 1 015. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A004
2. TITLE OF DATA ITEM
Item Unique Identification (IUID) Marking Plan
3. SUBTITLE
Item Unique Identification (IUID) Marking Plan
4. AUTHORITY
DI-MGMT-81803
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 4.4.2
6. REQUIRING OFFICE
407 SCMS/GUEA
7. DD 250 REQ
DD
8. APP CODE
A
9. DIST STATEMENT
REQUIRED
D
10. FREQUENCY
ASREQ
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
Edge, Russ ANAME: 16 OCT 2017DATE:
BLK 4. TAILORING OF DID REQUIREMENTS. CONTRACTOR FORMAT IS
ACCEPTABLE.
Block 7: Submit final with DD Form 250 to account for all previously submitted via WAWF for acceptance under DODAAC: FA8539.
BLK 8. APPROVAL OF PLAN OR COMMENTS SHALL BE FURNISHED WITH
APPROVAL/REJECTION.
BLK 9. DISTRIBUTION AUTHORIOZED TO U.S. GOVERNMENT AGENCIES
ONLY. OTHER REQUEST FOR THIS DOCUMENT SHOULD BE REFERRED TO 407
SCMS/GULB.
Block 10, 11, 12, 13: As required. The government will have 30 calendar days to review and provide comments, 407 SCMS/GULB
235 Byron St. Suite 19A Robins AFB, 31098-1813 Attn: Long Nguyen
1 1 0
1 1 015. TOTAL
Page 3 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017 subsequently the contractor will have 60 calendar days to correct and resubmit.
Block 14: Submissions shall be IAW CDRL instructions and PWS 4.4.2
COORDINATORS:
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A005
2. TITLE OF DATA ITEM
Item Unique Identification (IUID) Marking Activity and Verification Report
3. SUBTITLE
Item Unique Identification (IUID) Marking Activity and Verification Report
4. AUTHORITY
DI-MGMT-81804
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 4.4.4
6. REQUIRING OFFICE
407 SCMS/GUEA
7. DD 250 REQ
LT
8. APP CODE
See Block 16
9. DIST STATEMENT
REQUIRED
D
10. FREQUENCY
ASREQ
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
Edge, Russ ANAME: 16 OCT 2017DATE:
BLK 4. TAILORING OF DID REQUIREMENTS. CONTRACTOR FORMAT IS
ACCEPTABLE.
Block 7: Submit final with DD Form 250 to account for all previously submitted via WAWF for acceptance under DODAAC: FA8539.
BLK 8. APPROVAL OF PLAN OR COMMENTS SHALL BE FURNISHED WITH
APPROVAL/REJECTION.
BLK 9. DISTRIBUTION AUTHORIOZED TO U.S. GOVERNMENT AGENCIES
ONLY. OTHER REQUEST FOR THIS DOCUMENT SHOULD BE REFERRED TO 407
SCMS/GULB.
BLK 11-13. CONCURRENT WITH ASSOCIATED END ITEM DELIVERY..
Block 14: Submissions shall be IAW CDRL instructions and PWS 4.4.4
COORDINATORS:
407 SCMS/GUEA
235 Byron St. Suite 19A Robins AFB, GA 31098-1813 Attn: Long Nguyen
1 1 0
1 1 015. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
Page 4 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A006
2. TITLE OF DATA ITEM
Counterfeit Prevention Plan
3. SUBTITLE
CPP
4. AUTHORITY
DI-MISC-81832
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 4.6
6. REQUIRING OFFICE
407 SCMS/GUEA
7. DD 250 REQ
DD
8. APP CODE
A
9. DIST STATEMENT
REQUIRED
D
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
Edge, Russ ANAME: 16 OCT 2017DATE:
BLK 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative and Operational use, 31 December 2014. Other requests for this document shall be referred to the Program Manager Russ Edge, 409 SCMS/GULB BLK 8, 10, 11, and 12: Contractor shall deliver a Counterfeit Prevention Plan (CPP) within 30 days after contract award. Government comments will be provided to the contractor within 14 days after receipt, with contractor re-submittal due 7 days after receipt, with contractor re-submittal due 7 days after receipt of comments. Updates to the CPP shall be provided to the Government within twenty (20) calendar days after the initial counterfeit part(s) identification/notification.
Blk 13: Updates to the CPP shall be provided within twenty (20) calendar days after each additional counterfeit part(s) identification/notification.
Block 14: Submittal shall be made using Wide Area Workflow (WAWF) and accepted by the Government. When notification is submitted in WAWF the contractor shall provide email notification to russ.edge@us.af.mil, Contracting Officer Representative (COR) or Lead Engineer, long.nguyen.6@us.af.mil. Document submission shall be provided electronically via Microsoft Office word format (doc) or Portable Document Format (PDF).
Changes to office symbols and /or e-mail addresses, shall be made by letter to the PCO & ACO without further revision to this Contract Data Requirements List (CDRL).
COORDINATORS:
407 SCMS/GUEA
235 Byron St. Suite 19A Robins AFB, GA 31098-1813 Attn: Long Nguyen
1 1 0
1 1 015. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
Page 5 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A007
2. TITLE OF DATA ITEM
Government Industry Data Exchange Program (GIDEP) Alert/Safe Report
3. SUBTITLE
Alert/Safe Report
4. AUTHORITY
DI-QCIC-80125B
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 4.6.12
6. REQUIRING OFFICE
407 SCMS/GUEA
7. DD 250 REQ
LT
8. APP CODE
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. REMARKS
Edge, Russ ANAME: 16 OCT 2017DATE:
Block 4: Contractor format acceptable on electronic media. Data Item to be used as a guide for content.
Block 7: Submit final with DD Form 250 to account for all previously submitted via WAWF for acceptance under DODAAC: FA8539.
BLK 9. Approved for Public release; distribution is unlimited.
Block 10, 11, 12, 13: As required. The government will have 30 calender days to review and provide comments, subsequently the contractor will have 60 calender days to correct and resubmit.
Block 14: Procuring Officer(s) e-mail along with Integrated Product Team e-mail list will be provided as required. Lead Engineer, Long Nguyen, long.nguyen.6@us.af.mil
COORDINATORS:
407 SCMS/GUEA
235 Byron St. Suite 19A Robins AFB, 31098-1813 Attn: Long Nguyen
0 1 0
0 1 015. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
Page 6 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A008
2. TITLE OF DATA ITEM
Government Industry Data Exchange Program (GIDEP) Alert/Safe Response
3. SUBTITLE
Alert/Safe Response
4. AUTHORITY
DI-QCIC-80126B
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 4.6.13
6. REQUIRING OFFICE
407 scms/guea
7. DD 250 REQ
LT
8. APP CODE
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. REMARKS
Edge, Russ ANAME: 16 OCT 2017DATE:
Block 4: Contractor format acceptable on electronic media. Data Item to be used as a guide for content.
Block 7: Submit final with DD Form 250 to account for all previously submitted via WAWF for acceptance under DODAAC: FA8539.
BLK 9. Approved for Public release; distribution is unlimited.
Block 10, 11, 12, 13: As required. The government will have 30 calender days to review and provide comments, subsequently the contractor will have 60 calender days to correct and resubmit.
Block 14: Procuring Officer(s) e-mail along with Integrated Product Team e-mail list will be provided as required. Lead Engineer, Long Nguyen, long.nguyen.6@us.af.mil
COORDINATORS:
407 SCMS/GUEA
235 Byron St. Suite 19A Robins AFB, GA 31098-1813 Attn: Long Nguyen
0 1 0
0 1 015. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
Page 7 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A009
2. TITLE OF DATA ITEM
Commercial Asset Visibility Air Fore
3. SUBTITLE
CAV AF
4. AUTHORITY
DI-MGNT-81634C
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS para 4.7
6. REQUIRING OFFICE
FA8539
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. REMARKS
Sostarich, Jonn WNAME: 27 OCT 2017DATE:
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 SOW. This information will be accessed by the program office PMS and by 420 SCMS/GUNAB-Robins in order to ascertain production status.
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.
3. Training will be provided by 420 SCMS/GUNAB-Robins, (478) 327-6603 or 6602.
4. This DD Form 1423-1 applies to Contractor Furnished Materiel (CFM) type contracts.
Block 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.)
Block 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.
Block 11: Data shall be current within 24 hours of last End Item maintenance occurrence.
Block 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.
Block 13: Same as remarks regarding Block 10 above.
COORDINATORS:
15. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
Page 8 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A010
2. TITLE OF DATA ITEM
Accident/Incident Report
3. SUBTITLE
Accident/Incident Report
4. AUTHORITY
DI-SAFT-81563/T
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 5.5.2
6. REQUIRING OFFICE
78 ABW/SE
7. DD 250 REQ
DD
8. APP CODE
A
9. DIST STATEMENT
REQUIRED
B
10. FREQUENCY
ASREQ
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
Edge, Russ ANAME: 16 OCT 2017DATE:
BLK 4. Report ALL mishaps, damage to DOD property and employee injury to Installation Safety Office telephonically within four (4) hours after initial notification. Written notification required within 3 calendar days of mishap.
BLK 9. Distribute to U.S. Government ONLY.
BLK 11. Submit written report within 72 hours of mishap. Submit information that is not available at the time of the mishap within 20 calendar days after the mishap.
COORDINATORS:
407 SCMS/GULB
235 Byron St. Suite 19A Robins AFB, GA 31098-1813 Attn: Russ Edge
0 1 0
78 ABW/SEG
675 Seventh St Bld 707 Robins AFB, GA 30198-1813
0 2 0
WR-ALC/PCO
235 Byron St Suite 19A Robins AFB, GA 31098-1813 Attn: Bennie Simmons
0 1 0
0 4 015. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
Page 9 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP TM OTHER X
D. SYSTEM / ITEM
APN-224
E. CONTRACT / PR NO.
FD20601700396
F. CONTRACTOR
Honeywell
1. DATA ITEM NO.
A011
2. TITLE OF DATA ITEM
Quality Control Plan
3. SUBTITLE
QCP
4. AUTHORITY
DI-QCIC-81722
(Data Acquisition Document No.) 5. CONTRACT REFERENCE
PWS 5.9
6. REQUIRING OFFICE
407 SCMS/GULB
7. DD 250 REQ
LT
8. APP CODE
A
9. DIST STATEMENT
REQUIRED
D
10. FREQUENCY
1 XTIME
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
Edge, Russ ANAME: 16 OCT 2017DATE:
Block 4: Contractor format acceptable.
Block 7: Submit final with DD Form 250 to account for all previously submitted via WAWF for acceptance under DODAAC: FA8539.
BLK 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative and Operational use, 31 December 2014. Other requests for this document shall be referred to the Program Manager Russ Edge, 409 SCMS/GULB Block 10, 11, 12, 13: One submission is required for contract. The government will have 30 calender days to review and provide comments, subsequently the contractor will have 60 calender days to correct and resubmit.
Block 14: Submissions shall be IAW CDRL instructions and PWS 5.9
COORDINATORS:
407 SCMS/GULB
235 Byron St. Suite 19A Robins AFB,GA 31098-1813 Attn: Russ Edge
1 1 0
1 1 015. TOTAL
G. PREPARED BY
Burnett, Yolanda H
407 SCMS / GULB
478-926-3664
H. DATE
27 OCT 2017
I. APPROVED BY
//DIGITALLY SIGNED//
HOWELL.KRISTIN.A.1267479425
407 SCMS / GULBD 478-926-5064 / 468-5064
J. DATE
27 OCT 2017
Page 10 of 10DD FORM 1423-1, FEB 2001 Version 3Generated by PRPS using Jasper Reports on 22 Nov 2017
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