CDRLs.pdf

DD FORM 1423-2, AUG 96

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 220 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 (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 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 _________________________

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page ____ of ___ Pages

X

Environmental and Engineering Support

A001 Accident/Incident Report Mishap Notification and Reporting

DI-SAFT-81563/T PD para 4.5.3.3 and Appendix C WR-ALC/SE (Safety Office)

LT

N/A See Block 16

ASREQ

SeeBlock16

ASREQ

SeeBlock16

402 MXSG/OB-CSMO 1

420 Richard Ray Blvd Ste 100 Robins AFB GA 31098

WR-ALC/SE 1

420 Richard Ray Blvd

Ste 100 Robins AFB GA 31098

AFSC/PZIMB 1

375 Perry St, Bldg 255 Robins AFB GA 31098

0 3 0

Block 4: Reporting requirements for government property damage and injuries has changed; disregard dollar amount listed in DID. Report ALL mishaps, damage to DOD property and employee injury, to the WR-ALC/SE Safety Office telephonically immediately.

Block 9: Distribute to U.S. Government ONLY.

Block 11: Telephone notification of any accident/incident should be made immediately, defined as not more than 4 hours after occurrence. Submit written report within 3 calendar days of mishap.

Block 13: Submit information that is not available at the time of the accident/incident within 20 calendar days after occurrence.

A002 Contractor's Standard Operating Procedures Environmental Health and Safety Plan

DI-MGMT-81580/T PWS 4.5.4.1 and Appendix C WR-ALC/SE (Safety Office)

SEE BLK 16

N/A A

ONE/R

SEE BLK 16

See Blk 16

See Blk 16

WR-ALC/SE 1 1

420 Richard Ray Blvd Robins AFB GA 31098

1 1 0

BLK 4. DID, Para 3, Content. The contractor shall provide a copy of their Company Safety Plan required by 29 Code of Federal Regulation (CFR) Occupational Safety and Health Administration (OSHA) and the Occupational Safety and Health Act (Public Law 91-596). Contractor format in MS Office electronic format preferred.

BLK 8: Draft reviewed by: WR-ALC/SE 420 Richard Ray Blvd., Suite 100 Robins AFB GA 31098 BLK 12: Submit draft for approval within 10 calendar days after contract award.

BLK 13: Submit final copies 10 calendar days after Government (WR-ALC/SE) acceptance of draft. Revisions as required.

MORRIS.BRANDI.T.1229893277

Digitally signed by MORRIS.BRANDI.T.1229893277 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USAF, cn=MORRIS.BRANDI.T.1229893277 Date: 2017.03.17 12:59:07 -04'00'

17 Mar 2017 MORRIS.BRANDI.T.1229893277 Digitally signed by MORRIS.BRANDI.T.1229893277 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USAF, cn=MORRIS.BRANDI.T.1229893277 Date: 2017.03.17 12:59:38 -04'00'

17 Mar 2017

1 3 Adobe Professional 8.0

X005 A

F3QCCL7081A102

DD FORM 1423-2, AUG 96

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 220 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 (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 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 _________________________

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page ____ of ____ Pages

X

Environmental and Engineering Support

A003 Status Report

DI-MGMT-80368A/T PWS 4.6 WR-ALC QP

DD

N/A A

MONTHLY

See Blk 16

See Blk 16

MONTHLY

See Block 16 1

0 1 0

Block 4, DID format, Contractor format. Contractor format in MS Office or Adobe Acrobat Portable Document format (pdf) electronic format preferred.

Block 12. Shall be delivered no later than the 15th of the following month.

COR Copy:

402 MXSG/OB (CSMO), 420 Richard Ray Blvd, Suite 100, Robins AFB GA 31098

Contracting Officer Copy:

AFSC/PZIMB, 375 Perry Street, Bldg 255, Suite A, Robins AFB GA 31098

A004 Technical Report-Study/Service

DI-MISC-80508B PWS 1.3.2, 1.3.3, 1.4.1 WR-ALC QP

N/A

N/A A

See Blk 16

SEE Blk 16

See Blk 16

See Blk 16 See Block 16 1

0 1 0

Blocks 10, 11, 12, 13 All data developed shall be delivered to the the Government point of contacted specified in Block 16 via the original source development electronic media within five (5) calendar days of completion.

Block 14a Address:

402 MXSG/MXDEU

Attn: Richard Slife 420 Richard Ray Blvd., Suite 100 Building 165 Robins AFB GA 31098

MORRIS.BRANDI.T.1229893277

Digitally signed by MORRIS.BRANDI.T.1229893277 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USAF, cn=MORRIS.BRANDI.T.1229893277 Date: 2017.03.17 12:56:14 -04'00'

17 Mar 2017 MORRIS.BRANDI.T.1229893277 Digitally signed by MORRIS.BRANDI.T.1229893277 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USAF, cn=MORRIS.BRANDI.T.1229893277 Date: 2017.03.17 12:57:10 -04'00'

17 Mar 2017

2 3 Adobe Professional 8.0

X005 A

F3QCCL7081A102

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.

DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.

DD FORM 1423-2 (BACK), AUG 96