CDRLs.pdf

DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAY BE USED. Page of Pages

Adobe Professional 8.0

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

Reset

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items)

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 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

EMXG Production Support Bridge

E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Status Report

3. SUBTITLE

Status Report

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80368A

5. CONTRACT REFERENCE

PWS Para 4.11

6. REQUIRING OFFICE

402 EMXG/MXDSAB

7. DD 250 REQ

DD

9. DIST STATEMENT

REQUIRED

B

10. FREQUENCY

MONTHLY

12. DATE OF FIRST SUBMISSION

ASREQ

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

See Blk 16

13. DATE OF SUBSEQUENT

SUBMISSION

MONTHLY

Draft

Final

Reg Repro

16. REMARKS

BLKS 11, 12 & 13: Monthly status report shall be delivered no later than the 15th of following month.

The Contractor shall provide weekly labor reports for certification of services to the TPOC not later than TUESDAY of the following week. Values of hours worked shall be in whole number and then .25 increments for further break down only. The weekly labor hour report will be summarized in the Monthly Status Report.

BLK 14: Addressee

402 EMSS/MXDSAB

TPOC: Loretta Carter 402 Richard Ray Blvd., Suite 100 Robins AFB GA 31098

402 EMXG/MXDSAB 1

15. TOTAL 0 1 0

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

Funds & Man Hours Expenditure Report

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-FNCL-80331A

5. CONTRACT REFERENCE

PWS Para 4.11.1

6. REQUIRING OFFICE

402 EMXG/MXDSAB

7. DD 250 REQ

DD

B

MONTHLY

12. DATE OF FIRST SUBMISSION

8. APP CODE

N/A

11. AS OF DATE

See Blk 16

13. DATE OF SUBSEQUENT

SUBMISSAIOSN REQ

Draft

Final

Reg Repro

16. REMARKS

BLK 11. Report every four weeks to include quantity and category of labor hours expended during the report period for each individual charging to the task order. Values of hours worked shall be in whole number and then .25 increments for further break down only.

First submission of the FMHER report for Direct Personnel hours and Support Personnel hours shall be submitted by the 5th day following the end of the first reporting month (four weeks) after contract award.

BLK 14

Attn: Loretta Carter 402 Richard Ray Blvd., Suite 100 Robins AFB GA 31098

402 EMXG/MXDSAB 1

15. TOTAL 0 1 0

G. PREPARED BY

Phyllis M. Vail VAIL.PHYLLIS.M.1280273097 Digitally signed by VAIL.PHYLLIS.M.1280273097

Date: 2018.11.09 13:18:44 -05'00'

H. DATE

20181109

I. APPROVED BY

Phyllis M. Vail

Digitally signed by

VAIL.PHYLLIS.M.1280273097 VAIL.PHYLLIS.M.1280273097

Date: 2018.11.09 13:19:04 -05'00'

J. DATE

20181109

DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAY BE USED. Page of Pages

Adobe Professional 8.0

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

Reset

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items)

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 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

EMXG Production Support Bridge

E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM

Contractor's Safety Plan

3. SUBTITLE

Safety Plan

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-82080

5. CONTRACT REFERENCE

PWS Para. 4.14

6. REQUIRING OFFICE

WR-ALC/SE (Safety Office)

7. DD 250 REQ

No

A

1TIME

12. DATE OF FIRST SUBMISSION

See Blk 16

8. APP CODE

A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

See Blk 16

Draft

Final

Reg Repro

16. REMARKS

BLK 12: Submit draft of company safety plan for review/approval within 10 working days after contract award. Safety plan can be in Contractor format. Also submit the Appendix C that was supplied by the Government and annotate in the Appendix C anything the Contractor does not believe is applicable to the type of work to be performed.

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

BLK 14a: WR-ALC/SE AFSC/PZIOA

420 Richard Ray Blvd. 375 Perry St.

Robins AFB, GA 31098 Bldg. 255

Robins AFB, GA 31098

See Blk 16 2 2

15. TOTAL 2 2 0

1. DATA ITEM NO.

A004

2. TITLE OF DATA ITEM

Accident/Incident Report

3. SUBTITLE

Accident/Incident Report

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-81563 NOT 1

5. CONTRACT REFERENCE

PWS Para. 4.14.1

6. REQUIRING OFFICE

WR-ALC/SE (Safety Office)

7. DD 250 REQ

No

A

ASREQ

12. DATE OF FIRST SUBMISSION

8. APP CODE

A

11. AS OF DATE

ASREQ

13. DATE OF SUBSEQUENT

SUBMISSAIOSN REQ

Draft

Final

Reg Repro

16. REMARKS

Block 11: Telephone notification of any accident/incident should be made immediately and 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.

Block 14a: WR-ALC/SE AFSC/PZIOA

420 Richard Ray Blvd. 375 Perry St.

Robins AFB, GA 31098 Bldg. 255

Robins AFB, GA 31098

See Blk 16 2 2

15. TOTAL 2 2 0

G. PREPARED BY

Phyllis M. Vail VAIL.PHYLLIS.M.1280273097 Digitally signed by VAIL.PHYLLIS.M.1280273097

Date: 2018.11.09 13:20:17 -05'00'

H. DATE

20181109

I. APPROVED BY

Phyllis M. Vail

Digitally signed by

VAIL.PHYLLIS.M.1280273097 VAIL.PHYLLIS.M.1280273097

Date: 2018.11.09 13:20:31 -05'00'

J. DATE

20181109

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

DD FORM 1423-2 (BACK), AUG 96