SignedCDRLs_Attch_3.pdf

CONTRACT DATA 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 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:

A TOP TM OTHER MGMT

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

C2ISR Div. ECLS Contract TBD

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

AOOI Contractor's Progress, Status and Management Report Monthly Status Report (MSR)

4. AUTHORITY (Data Acquisition Document No.) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-80227/T See Block 16 AFLCMC/HBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

MTHLY 30DAC DD b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft NIA 0 15 DARP Reg Re pro

16. REMARKS AFLCMC/HBGML I

Block 4: 235 Byron Street

- Delete reference to sections I 0.3f and g. The letter transmitting the Monthly Status Suite 19A Report (MSR) shall state that the data transmitted have been validated through the cutoff Robins AFB GA 31098 date of the accounting period. (E-mail - See Block 16)

- Delete 10.3j requirement to report "significant results." The trip report (CORL AO 10) covers results of business travel accomplished for this contract.

AFLCMC/HBKA I

Blocks 4, 5: The MSR shall include requested information as indicated in PWS paras 235 Byron Street 4.2.2, 4.2.2.4, 4.2.6, 4.3. 1, 4.3.14.1, 4.4.4.1, 4.6. 7.1. Suite l 9A

Robins AFB GA 31098 Block 7: The Government will accept the Receiving Report through WA WF. Contractor (E-mail - See Block 16) shall submit the Receiving Report upon final submission.

Block 9: The following information shall be included on the deliverable:

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron Street, Suite 19A, Robins AFB, GA 31098-1670.

WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of

1979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive

5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Block 12 & 13: Thirty (30) calendar days after contract award. Submit each subsequent

MSR 15 days after the reporting period (previous month).

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft (MS) Office 2003, or later electronic format to Government Procurement Contracting

. Officer (PCO) and COR. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

15. TOTAL 0 2 0

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

9 Jun 2016 MANGRUM.SCOTT.T.12288 1,:~~' ,, )~" 15 Jun 2016 PARISH.MARGIE. D.1229930113 ~ .. : .................. ""1'1..1.>ul''F .................... ?'9~7 m M""" ""•'"''' DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of_l_ Pages

Adobe Professional 8.0

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

(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 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:

A TOP TM OTHER ADMN

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

C2ISR Div. ECLS Contract TBD

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

A002 Conference Agenda NIA

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

DI-ADMN-81249A PWS paragraph 4.2.2.3 AFLCMC/HBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED As Req'd SeeBlk16 DD b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft NIA 0 As Req'd Reg Re pro

16. REMARKS AFLCMC/HBGML 1

Block 7: The Government will accept the Receiving Report through WAWF. Contractor 235 Byron Street shall submit the Receiving Report upon final submission. Suite 19A

Robins AFB GA 31098

Block 9: The following information shall be included on the deliverable: (E-mail - See Block 16)

"DISTRJBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron AFLCMC/HBKA 1 Street, Suite I 9A, Robins AFB, GA 31098-1670. 235 Byron Street

Suite 19A WARNING: This document contains technical data whose export is restricted by the Arms Robins AFB GA 31098 Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of (E-mail - See Block 16) 1979, as amended, Title 50, U.S.C., 240 I et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive

5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Block 12: Conference Agenda shall be provided 14 calendar days prior to event.

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft (MS) Office 2003, or later electronic format to Government Procurement Contracting

Officer (PCO) and COR. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

15. TOTAL 0 2 0

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

9 Jun 2016 Scott T. Mangrum

15 Jun 2016

PARISH.MARGIE. D.1229930113 MANGRUM.SCOTT.T.12288

""''"""°''""'"'""""' ?<;9R7 . """' ""' "''"'""'

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of_l_ Pages

Adobe Professional 8.0

17. PRICE GROUP

( 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 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:

A TOP TM OTHER ADMN

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

C2ISR Div. ECLS Contract TBD

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

A003 Presentation Materials NIA

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

DI-ADMN-81373 PWS paras 4.2.2.1, 4.2.2.2, 4.2.2.3

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

REQUIRED

As Req'd SeeBlkl6 DD

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

c SUBMISSION NIA 0 As Req'd

16. REMARKS

Block 7: The Government will accept the Receiving Report through WA WF. Contractor shall submit the Receiving Report upon final submission.

Block 9: The following information shall be included on the deliverable:

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron Street, Suite l 9A, Robins AFB, GA 31098-1670.

WARNING: This document contains technical data whose export is restricted by the Arms

Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of J 979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive

5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Block 12: Presentation materials shall be provided 7 calendar days prior to event.

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft (MS) Office 2003, or later electronic format to Government Procurement Contracting

Officer (PCO) and COR. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

G. PREPARED BY H. DATE I. APPROVED BY

9 Jun 2016 Scott T. Mangrum

PARISH.MARGIE.D.1229930113 !~":·":;·::·~·~ •« .... :.:.~:": .. :. "'"l- MANGRUM.SCOTT.T.12288 "··· '"""""''"·' "-~"" 219R7

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED.

6. REQUIRING OFFICE

AFLCMC/HBGML

14. DISTRIBUTION

b. COPIES

a. ADDRESSEE Final Draft

Reg Re pro

AFLCMC/HBGML 1

235 Byron Street Suite 19A Robins AFB GA 31098

(E-mail - See Block 16)

AFLCMC/HBKA 1

235 Byron Street

Suite 19A

Robins AFB GA 31098

(E-mail - See Block 16)

15. TOTAL 0 2 0

J. DATE

.... •u '\f 15 Jun 2016

Page 1 of_l_ Pages

Adobe Professional 8.0

17. PRICE GROUP

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 OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the ContractJPR No. listed in Block E.

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

A TOP TM OTHER ADMN

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

C2ISR Div. ECLS Contract TBD

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

A004 Conference Minutes NIA

4. AUTHORITY (Data Acquisition Document No.) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-ADMN-81250A/T PWS paragraph 4.2.2.3 AFLCMC/HBGML

7. DD 250 REQ 9. DIST STATEMENT 10.FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED As Req'd See Blk 16 DD b. COPIES

B. APP CODE 11.ASOFDATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft NIA 0 As Req'd Reg Re pro

16. REMARKS AFLCMC/HBGML 1

Block 4: 235 Byron Street

- Delete item l 0.2a(3). Contractor and agency representative signatures are not required. Suite 19A

Robins AFB GA 31098

Block 7: The Government will accept the Receiving Report through WA WF. Contractor (E-mail - See Block 16) shall submit the Receiving Report upon final submission.

Block 9: The following information shall be included on the deliverable: AFLCMC/HBKA 1 235 Byron Street

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies Suite 19A and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron Robins AFB GA 31098 Street, Suite 19A, Robins AFB, GA 31098-1670. (E-mail - See Block 16)

WARNING: This document contains technical data whose export is restricted by the Arms

Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws arc subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive

5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Block 12: Conference minutes shall be provided 10 business days after event conclusion.

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft

(MS) Office 2003, or later electronic format to Government Procurement Contracting Officer (PCO) and COR. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

15.TOTAL 0 2 0

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

9Jun2016 Scott T. Mangrum

15 Jun 2016 PARISH.MARGIE.D.1229930113 ;;,: 'i.::;:~~:;~:~::~: : : . MANGRUM.SCOTT.T.12288 '" "" 25987 m :,:;;, ,, DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page _I_ of I Pages Adobe Professional 8.0

17. PRICE GROUP

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:

A TOP TM OTHER MGMT

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

C2ISR Div. ECLS Contract TBD

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

A005 Management Plan Project Management Plan

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

DI-MGMT-80004A/T PWS paragraph 4.2.2.4 AFLCMC/HBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

As Req'd See Blk 16 DD b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft A 0 See Blk 16 Reg Repro

16. REMARKS AFLCMC/HBGML 1 1

Block 4: 235 Byron Street

- Item 2c. Omit type written or printed. Electronic format is acceptable using Microsoft Suite 19A Office or equivalent. Remainder of this item applies. Robins AFB GA 31098

(E-mail - See Block 16) Block 7: The Government will accept the Receiving Report through WA WF. Contractor shall submit the Receiving Report upon final submission.

AFLCMC/HBKA 1 1

Block 9: The following information shall be included on the deliverable: 235 Byron Street

Suite l 9A "DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies Robins AFB GA 31098 and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron (E-mail - See Block 16) Street, Suite 19A, Robins AFB, GA 31098-1670.

WARNING: This document contains technical data whose export is restricted by the Arms

Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Block 8, 12: The Contractor shall submit a draft Project Management Plan (PMP) within I 0 calendar days after contract award. Written Government acceptance/comments will be within 10 calendar days after receipt of PMP. Contractor final submission shall be within

10 calendar days of receipt of Government comments. Acceptance by the Government is required prior to fonnal distribution.

Block 13: The Contractor shall update the PMP as required and deliver updated PMP to the Government within 15 calendar days of completion with a summary of changes included within the document. The Contractor shall update the PMP upon significant changes in organizational structure or key personnel. Procedures identified for blocks 8, 12 will apply.

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft (MS) Office 2003, or later electronic format to Government Procurement Contracting Officer (PCO) and COR. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

15. TOTAL 2 2 0

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

9 Jun 2016 Scott T. Mangrum

15 Jun 2016 PARISH.MARGIE.D.1229930113 ·;".~'""'"'" '" "'" ',, MANGRUM.SCOTT.T.12288 ~~:::::·( ,,\j-.

!>"'''"""""'"'''"'"''"' 1'i9R 7 • . oo··~· ... ,.

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page _1_ of_l_ Pages Adobe Professional 8.0

17. PRICE GROUP

CONTRACT DAT A REQUIREMENTS LIST Form Approved

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 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:

A TOP TM OTHER MGMT

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

C2ISR Div. ECLS Contract TBD

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

A006 Maintenance Services Report Summary of Repairs

4. AUTHORITY (Data Acquisition Document No.) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-80995A/T PWS paragraph 3.2.1 AFLCMCIHBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED lTIME See Blk 16 NO b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION

NIA NIA NIA

16. REMARKS

Block4: Tailor item 3 as follows: Contractor shall include with the Summary of Repairs report all receipts/invoices containing tasks perfonned or items purchased and prices paid.

Remainder of this item applies.

Block 9: The following information shall be included on the deliverable:

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGM L, 235 Byron

Street, Suite l 9A, Robins AFB, GA 31098-1670.

WARNING: This document contains technical data whose export is restricted by the Arms

Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of

1979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive

5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Block 12: Submit report upon completion ofrepairs no later than 4 weeks after contract award to Government POC listed below.

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft

(MS) Office 2003, or later electronic format to Government Procurement Contracting

Officer (PCO) and COR. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

G. PREPARED BY H. DATE I. APPROVED BY

9Jun2016 Scott T. Mangrum

PARISH.MARGIE D 1229930113 """'" "''" MANGRUM.SCOTT.T.12288

~.!""'"'".,. '""'"' ?'9R7

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED.

Draft Reg Repro

AFLCMC/HBGML 1

23 5 Byron Street Suite 19A Robins AFB GA 31098

(E-mail - See Block 16)

AFLCMC/HBKA 1

23 5 Byron Street

Suite 19A

Robins AFB GA 31098

(E-mail - See Block 16)

15. TOTAL 0 2 0

J. DATE

1c:""''""" 15 Jun 2016 '" 1'0..1 "" I ~\f . '"'';"""''"""

Page _l_ of 1 Pages Adobe Professional 8.0

17. PRICE GROUP

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 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:

A TOP TM OTHER MGMT

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

C2ISR Div. ECLS Contract TBD

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

A008 Material Utilization and Forecasting Report Inventory Adjustment Report

4. AUTHORITY (Data Acquisition Document No.) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-81947A/T PWS paragraph 4.3.22 AFLCMC/HBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

Monthly See Blk 16 DD b. COPIES

B. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft NIA 0 Monthly Reg Repro

16. REMARKS AFLCMC/HBGML 1

Block 4: Contractor format is acceptable. 235 Byron Street

- Replace item 2 contents in entirety as follows: Suite 19A

Robins AFB GA 31098

"The Inventory Adjustment Report shall include the following data: (E-mail - See Block 16)

- Part Number

- Nomenclature

- Quantity (from/to) AFLCMC/HBKA 1

- Estimated Unit Cost 23 5 Byron Street

- Extended price Suite I 9A

- Quantity Per End Item (QPEI) Robins AFB GA 3 I 098

- Justification (E-mail - See Block 16)

- Current authorized allowance/stock level and recommended new stock level indicating the time frame being supported

- Estimated delivery date"

Block 7: The Government will accept the Receiving Report through W AWF. Contractor shall submit the Receiving Report upon final submission.

Block 9: The following information shall be included on the deliverable:

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron Street, Suite I 9A, Robins AFB, GA 31098-1670.

WARNING: This document contains technical data whose export is restricted by the Arms

Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Block 12: Within 30 days after contract award.

Block 14: Submission via Government approved electronic format (ALMSS/CALMSS MSSM32 Report). Notify Government Procurement Contracting Officer (PCO) and COR by e-mail ofreport completion. The PCO and COR e-mail addresses will be provided in

15. TOTAL 0 2 0

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

9 Jun 2016 Scott T. Mangrum

PARISH.MARGIE.D.1229930113 .. ~: ~::· ::~f .~;~~'.~~::; :: ' MANGRUM.SCOTT.T.12288 I 1::~•>.J•" 15 Jun 2016 25987 .. ,. .. ·,:','~~7leCn;·K~~'~l~~ 'I! \'f..I. ''" I S \I

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page _1_ of 2 Pages

Adobe Professional 8.0

17. PRICE GROUP

CONTRACT DATA REQUIREMENTS LIST

( 1 Data Item)

A. CONTRACT LINE ITEM NO.

I B. EXHIBIT I c. CATEGORY: MGMT

A TOP __ TM __ OTHER ------------------

D. SYSTEM/ITEM

C2ISR Div. ECLS Contract

IE. CONTRACT/PR NO. IF. CONTRACTOR

TBD

16. REMARKS (Continued)

Block 14 (cont'd): the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

DD FORM 1423-1. FEB 2001 Page_2_ of __ 2_Pages

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 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:

A TOP TM OTHER PSSS

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

C2ISR Div. ECLS Contract TBD

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

A009 Bill of Materials (BOM) for Diminishing Manufacturing DMSMS Forecasting/Reporting

Sources and Material Shortages Management

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

DI-PSSS-81656A/T PWS paragraph 4.6.6 AFLCMC/HBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED As Req'd As Req'd DD b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft NIA 0 As Req'd Reg Re pro

16. REMARKS

Block 4: Tailor para 3 as follows, "The BOM shall be provided in Microsoft Excel spreadsheet format."

Block 7: The Government will accept the Receiving Report through W AWF. Contractor shall submit the Receiving Report upon final submission.

Block 9: The following information shall be included on the deliverable:

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron

Street, Suite l 9A, Robins AFB, GA 3 1098-16 70.

WARNING: This document contains technical data whose export is restricted by the Arms

Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of

1979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft

(MS) Office 2003, or later electronic format to Government Procurement Contracting

Officer (PCO) and COR. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

G. PREPARED BY H. DATE I. APPROVED BY

9 Jun 2016 Scott T. Mangrum

PARISH.MARGIE. D.1229930113 MANGRUM.SCOTT.T.12288

""'"""" ll•••'"'""'"''"''""' .. '"''' 2S987

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED.

AFLCMC/HBGML 1

23 5 Byron Street Suite l 9A Robins AFB GA 31098

(E-mail - See Block 16)

AFLCMC/HBKA 1

23 5 Byron Street

Suite 19A

Robins AFB GA 31098

(E-mail - See Block 16)

15. TOTAL 0 2 0

J. DATE

~11.!'><;l{I 12:"":"'"" 15 Jun 2016 ~\;;;::;. 'ul'"-1."'

Page 1 of_l_ Pages Adobe Professional 8.0

17. PRICE GROUP

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 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:

A TOP TM OTHER MISC

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

C2ISR Div. ECLS Contract TBD

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

AOOA Technical Report - Study/Services Trip Report

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

DI-MISC-80508B PWS paragraph 4.10.5 AFLCMC/HBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

See Blk 16 See Blk 16 DD b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft NIA 0 See Blk 16 Reg Re pro

16. REMARKS AFLCMC/HBGML 1

Block 7: The Government will accept the Receiving Report through WA WF. Contractor 2 3 5 Byron Street shall submit the Receiving Report upon final submission. Suite 19A

Robins AFB GA 31098

Block 9: The following information shall be included on the deliverable: (E-mail - See Block 16)

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron AFLCMC/HBKA 1 Street, Suite l 9A, Robins AFB, GA 31098-1670. 23 5 Byron Street

Suite l 9A WARNING: This document contains technical data whose export is restricted by the Arms Robins AFB GA 31098 Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of (E-mail - See Block 16) 1979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive

5230.25. '

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Blocks 10, 12-13: Within 10 calendar days of completing an authorized business trip, the Contractor shall submit a trip report to the contract/task order's COR and Government PM.

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft (MS) Office 2003, or later electronic format to Government Procurement Contracting Officer (PCO) and COR. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

15. TOTAL 0 2 0

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

9Jun2016 Scott T. Mangrum

15 Jun 2016 PARJSH.MARGIEH 1229930113 :::":':;",'.7~:.:::::.::, .• MANGRUM.SC'OTT.T. 12288

• ·~:,~;, MM:•:;~7,•:;~ ' rn.

ll~· ·"""''''''" '";'"~'"' 2'i987

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of 1 Pages Adobe Professional 8.0

17. PRICE GROUP

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 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:

A TOP TM OTHER MISC

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

C2ISR Div. ECLS Contract TBD

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

AOOB Technical Report - Study/Services Mission Essential Services Plan

4. AUTHORITY !Data Acquisition Document No.) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

Dl-MISC-80508BIT PWS paragraph 5. 1.3 .1 AFLCMCIHBGML

7. DD 250 REC 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION RE OU IRED As Req'd See Blk 16 DD b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft NIA NIA See Blk 16 Reg Repro

16. REMARKS

Block 4: The plan must, at a minimum, address:

( 1) Challenges associated with maintaining essential Contractor services during an extended event, such as a pandemic that occurs in repeated waves;

(2) The time lapse associated with the initiation of acquisition of essential personnel and resources and their actual availability on site;

(3) The components, processes, and requirements for the identification, training, and preparedness of personnel who are capable of relocating to alternate facilities or performing work from home;

(4) Any established alert and notification procedures for mobilizing identified "essential contractor service" personnel; and

(5) The approach for communicating expectations to Contractor employees regarding their roles and responsibilities during a crisis.

Block 7: The Government will accept the Receiving Report through W AWF. Contractor shall submit the Receiving Report upon final submission.

Block 9: The following information shall be included on the deliverable:

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron Street, Suite l 9A, Robins AFB, GA 31098-1670.

WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., 240 l et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Blocks 10, 12 & 13: The plan shall be submitted to the U.S. Government within 24 hours after notification by the PCO.

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft (MS) Office 2003, or later electronic format to Government Procurement Contracting

Officer (PCO) and COR. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall

G. PREPARED BY H. DATE I. APPROVED BY

9 Jun 2016 Scott T. Mangrum

PARISH.MARGIE.D.1229930113 :::·~·: ;"~' ~ :.:::~, MANGRUM.SCOTT .T.12288

'" ""'"""""'"'"'""""" ?)9R7

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED.

AFLCMC/HBGML 1

235 Byron Street Suite 19A Robins AFB GA 31098

(E-mail - See Block 16)

AFLCMC/HBKA 1

235 Byron Street

Suite l 9A

Robins AFB GA 31098

(E-mail - See Block 16)

15. TOTAL 0 2 0

J. DATE

,, ___ ...... "·" IC~''""'- 15 Jun 2016 ~Id '" I ~;,t· . ,,,.,n ''"'"""""

Page _l_ of_2_ Pages Adobe Professional 8.0

17. PRICE GROUP

A. CONTRACT LINE ITEM NO.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

I B. EXHIBIT I c. CATEGORY: MISC

A TOP __ TM __ OTHER ------------------

D. SYSTEM/ITEM

C2ISR Div. ECLS Contract

IE. CONTRACT/PR NO. IF. CONTRACTOR

TBD

16. REMARKS (Continued)

Block 14 (cont'd): be screened for virus and delivered virus free.

DD FORM 1423-1, FEB 2001 Page_2_ of __ 2_Pages

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 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:

A TOP TM OTHER SAFT

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

C21SR Div. ECLS Contract TBD

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

AOOC Accident/Incident Report Mishap Notification and Reporting

4. AUTHORITY (Data Acquisition Document No.} 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-SAFT-81563/T PWS paragraph 5.5.3.2 AFLCMC/HBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION REQUIRED As Req'd As Req'd DD b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft NIA See Blk 16 As Req'd Reg Repro

16. REMARKS AFLCMC/HBKA 1

Block 4: Tailor Item 2 as follows: ATTN: Cheryl Janssen Mishap notifications shall contain, at a minimum, the following information: 235 Byron Street •Contract, Contract Number, Name and Title of Person(s) Reporting Suite l 9A

• Date, time and exact location of accident/incident Robins AFB GA 31098

• Brief narrative of accident/incident (Events leading to accident/incident) (E-mail - See Block 16)

• Cause of accident/incident, if known

• Estimated cost of accident/incident (material and labor to repair/replace) AFLCMC/HBGML 1

• Nomenclature of equipment and personnel involved in accident/incident ATTN: Joe Eckersley •Corrective actions (taken or proposed) 23 5 Byron Street

• Other pertinent information Suite 19A

Robins AFB GA 31098 Block 7: The Government will accept the Receiving Report through WAWF. Contractor (E-mail - See Block 16) shall submit the Receiving Report upon final submission.

AFLCMC/SES 1

Block 9: The following information shall be included on the deliverable: ATTN: Valerie Smith

Bldg 301, 2nd Floor "DISTRIBUTION ST A TEMENT C: Distribution authorized to U.S. Government Agencies NE Wing, Post 2E5 and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron Robins AFB GA 31098 Street, Suite I 9A, Robins AFB, GA 31098-1670. (E-mail - See Block 16)

WARNING: This document contains technical data whose export is restricted by the Arms 78 ABW/SEG 1 Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of 215 Page Road, Ste 106 1979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws are subject Robins AFB GA 31098 to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive (E-mail - See Block 16) 5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Blocks I 0-13: Contractor shall submit a report on ALL mishaps, damage to DoD property, and employee injury, to the Installation Safety Office, AFLCMC Safety Office, and

Program Office telephonically within four (4) hours after initial notification. Written report shall be submitted within three (3) calendar days of mishap. Electronic submissions are acceptable. Information that is not available at the time of the initial notification shall be provided within 20 calendar days after the mishap.

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft

(MS) Office 2003, or later electronic format to Government Procurement Contracting

15.TOTAL 0 4 0

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

9Jun2016 Scott T. Mangrum

15 Jun 2016 PARISH.MARGIE.D.1229930113 :::;\;,'.:':'.Ji.::~;;;;; MANGRUM.SCOTT.T.12288 ;'.~,':'~:':~: ......•• ~.>J', p.,,,"""""'"''"''"""" 25987 1~,·'.'} .. -'.~.:,~~,-~., DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of 2 Pages

Adobe Professional 8.0

17. PRICE GROUP

CONTRACT DAT A REQUIREMENTS LIST

(1 Data Item}

A. CONTRACT LINE ITEM NO.

I

B. EXHIBIT I c. CATEGORY:

A TOP __ TM __ OTHER _S_A_F_T _______________ _

D. SYSTEM/ITEM

C2ISR Div. ECLS Contract

IE. CONTRACT/PR NO. IF. CONTRACTOR

TBD

16. REMARKS (Continued)

Block 14 (cont'd): Officer (PCO), COR, Installation Safety Office, and AF LC MC Safety Office. The aforementioned e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

DD FORM 1423-1, FEB 2001 Page_2_ of __ 2_Pages

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 t0704-0188). 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:

A TOP TM OTHER ENVR

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

C2ISR Div. ECLS Contract TBD

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

AOOD Environmental Health and Safety Plan (HSP) Safety and Health Plan

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

DI-ENVR-81375 PWS paragraph 5.5.4 AFLCMC/HBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

See Blk 16 See Blk 16 DD b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft A See Blk 16 See Blk 16 Reg Re pro

16. REMARKS

Block 4 & 5: Contractor format is acceptable.

Block 7: The Government will accept the Receiving Report through WA WF. Contractor shall submit the Receiving Report upon final submission.

Block 9: The following information shall be included on the deliverable:

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron

Street, Suite l 9A, Robins AFB, GA 31098-1670.

WARNING: This document contains technical data whose export is restricted by the Arms

Export Control Act (Title 22, U.S.C. Sec 2751, et seq.) or the Export Administration Act of

1979, as amended, Title 50, U.S.C., 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive

5230.25.

DESTRUCTION NOTICE: For unclassified limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document."

Block 8, 10-12: Contractor shall submit a Safety and Health Plan within 10 working days after contract award. Written Government acceptance/comments will be within I 0 working days after receipt of data. Contractor final submission shall be submitted within 10 working days of receiving Government comments. Acceptance by the Government is required prior to formal distribution.

Block 13: If, during the performance of this contract, changes to the Safety and Health Plan are required, submit the revised Safety and Health Plan to AFLCMC/HBKA and the Safety Office, AFLCMC/SES. Procedures identified for blocks 8, 10-12 will apply.

Block 14: Submission via electronic mail (e-mail) in Government approved Microsoft (MS) Office 2003, or later electronic format to Government Procurement Contracting

Officer (PCO), COR, and AFLCMC Safety Office. The aforementioned e-mail addresses will be provided in the contract or in a separate contractual memorandum. All electronically delivered files shall be screened for virus and delivered virus free.

G. PREPARED BY H.DATE I. APPROVED BY

9 Jun 2016 Scott T. Mangrum

PARISH.MARGIE.D 1229930113 ~\ '""" ",,::.:,;;~~;;~.:·: .. ~·.~ ,','"'' '" l'tl

MANGRUM.SCOTT.T.12288

""'""" 25987

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED.

AFLCMC/HBKA 1 1

ATTN: Cheryl Janssen 23 5 Byron Street Suite 19A

Robins AFB GA 31098 (E-mail - See Block 16)

AFLCMC/HBGML 1 1

ATTN: Joe Eckersley

235 Byron Street

Suite 19A

Robins AFB GA 31098 (E-mail - See Block 16)

AFLCMC/SES 1 1

ATTN: Valerie Smith

Bldg 301, 2nd F

NE Wing, Post 2E5

Robins AFB GA 31098

(E-mail - See Block 16)

15. TOTAL 3 3 0

J.DATE

15 Jun 2016

Page 1 of_l_ Pages

Adobe Professional 8.0

17. PRICE GROUP

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 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:

A TOP TM OTHER MISC

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

C2ISR Div. ECLS Contract TBD

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

AOOE Notice of Excess Airline Ticket Cost Excess Airline Ticket Cost Approval Request

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

DI-MISC-81363 PWS paragraph 4.10.2 AFLCMCIHBGML

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

See Blk 16 See Blk 16 DD b. COPIES

B. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final c SUBMISSION Draft NIA NIA See Blk 16 Reg Re pro

16. REMARKS

Block 7: The Government will accept the Receiving Report through W AWF. Contractor shall submit the Receiving Report upon final submission.

Block 9: The following information shall be included on the deliverable:

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors. Other requests shall be referred to AFLCMC I HBGML, 235 Byron Street, Suite l 9A, Robins AFB, GA 3 I 098-1670.

WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C.