A006 Requirements Certification.doc

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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

Eglin AFB MMHS

E. CONTRACT/PR NO.

PR Number

F. CONTRACTOR

1. DATA ITEM NO.

A006

2. TITLE OF DATA ITEM

Cerificate of Compliance

3. SUBTITLE

Requirements Certification

17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.)

FAR 52.246-15

5. CONTRACT REFERENCE

PD Paragraph 3.4

6. REQUIRING OFFICE

403 SCMS/GUEC

18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ

LT

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ONE/R

12. DATE OF FIRST SUBMISSION

See Block 16 14.

DISTRIBUTION

b. COPIES

8. APP CODE

AN

11. AS OF DATE

13. DATE OF SUBSEQUENT

SUBMISSION

See Block 16

16. REMARKS

Block 4: The requirements certifications shall, at a minimum, consist of a separate statement for each requirement in Block 5 certifying that the requirement has been met or exceeded. Supporting documentation shall be provided with each certification. All supporting documentation shall clearly identify the requirement it supports. A general statement that the delivered system meets or exceeds all system requirements is not acceptable.

Block 12: Upon successful completion of the system checkout test.

Block 13: The Contractor shall have 15 days to resubmit corrected requirement certifications.

Block 14: (a) Contractor shall send transmittal letter with this data item to all addressees, stating who received data item and indicating contract line item number (CLIN) data item is submitted against (copy of letter of transmittal only to ASC/PKESM).

(b) All items shall be dated.

403 SCMS/GUEC

5215 Thurlow Street

SUITE 5

WPAFB OH

45433-5006

ASC/PKESM

2275 D Street

Bldg 16, Rm 128

WPAFB OH

45433-7218

See Block 16

33rd Maint. Group

AMU Bldg 1417

Eglin AFB

FL

32542

15. TOTAL

G. PREPARED BY

Andrew J. Huser

H. DATE

23 Jul 2010

I. APPROVED BY

Andrew J. Huser

J. DATE

23 Jul 2010

DD FORM 1423-1, AUG 96 (EG)

PREVIOUS EDITION MAY BE USED.

Page __1_ of __1_ Pages

Designed using Perform Pro, WHS/DIOR, Aug 96

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 1423-1, AUG 96