11.1 Atch 1 Amend 1 - Sources & Components CDRLs_JTO Tailored.pdf

CONTRACT DATA REQUIREMENTS LIST (Data Item) Form Approval OMB No. 0704-0188 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. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA EXHIBIT ......................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0005

CATEGORY ................................... : OTHER F. CONTRACTOR :

1. DATA ITEM NO. ...................... : A001

2. TITLE OF DATA ITEM ........... : Presentation Materials

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-ADMN-81373 (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : DE JTO 9.DIST. STATEMENT REQUIRED ........ : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10.FREQUENCY ........................................ : (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ....................................... : None

14. DISTRIBUTION A. ADDRESSEES B. COPIES

DRAFT FINAL

COTR 1

DE JTO PM’s Office 1 AFRL RDKT Lt ACO Lt

15.TOTAL: 0 2

16. REMARKS

Block 4: Format of materials will be in accordance with paragraphs 3.1 and 10.1 of the DATA ITEM DESCRIPTION.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD 5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

Distribution Statement B if containing Proprietary Information:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (MARK ONLY ON PAGES THAT CONTAIN

PROPRIETARY DATA AND MAKE A NOTE ON TITLE PAGE)

Or the Distribution Statement C if containing no proprietary information:

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT THAT IS NOT MARKED BY ANOTHER DISTRIBUTION STATEMENT.)

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

Block 10, 12 and 13: The contractor will deliver formal briefing presentation materials TWO (2) working days prior to the presentation. No data item is required for informal briefings.

Block 14: Deliver an electronic version (Microsoft format) on CD-ROM (CD-R) or send via other appropriate electronic means.

When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18. ESTIMATED TOTAL PRICE:

G. PREPARED BY: Diana Loree I. APPROVED BY:

H. DATE: 30 July 2020 J. DATE:

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 1 of 6 pages

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. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA EXHIBIT ......................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0005

CATEGORY ................................... : OTHER F. CONTRACTOR ...... :

1. DATA ITEM NO. ...................... : A002

2. TITLE OF DATA ITEM ........... : Status Report

3. SUBTITLE ................................. : Technical Status Report (TSR)

4. AUTHORITY ............................ : DI-MGMT-80368A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : DE JTO 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : LT 10. FREQUENCY……………………...: (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : None

14. DISTRIBUTION A. ADDRESSEES B. COPIES

DRAFT FINAL

COTR 1

DE JTO PM’s Office 1

15. TOTAL: 0 2

Blk 4: Tailored: Para 3.2.3 Itemized man-hours and costs. Itemized man-hour and cost expenditure incurred for the reporting period by category and task, and Accounting Classification Reference Number (ACRN); total contractual expenditures, and fund remaining as of the reporting date.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD 5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

Distribution Statement B if containing Proprietary Information:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (MARK ONLY ON PAGES THAT CONTAIN

PROPRIETARY DATA AND MAKE A NOTE ON TITLE PAGE)

Or the Distribution Statement C if containing no proprietary information:

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT THAT IS NOT MARKED BY ANOTHER DISTRIBUTION STATEMENT.)

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

Block 10, 12 and 13: Provide monthly status reports NLT seven (7) calendar days following the close of the contractor’s monthly accounting period through completion of the contract technical period of performance, with a final status report after contract completion. Reports shall be summarized by contract through contract completion.

Block 14: Deliver an electronic version (Microsoft format) on CD-ROM (CD-R) or send via other appropriate electronic means. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18. ESTIMATED TOTAL PRICE:

G. PREPARED BY: Diana Loree I. APPROVED BY:

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 2 of 6 pages

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. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA EXHIBIT ......................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0005

CATEGORY ................................... : OTHER F. CONTRACTOR ...... :

1. DATA ITEM NO. ...................... : A003

2. TITLE OF DATA ITEM ........... : Scientific and Technical Report (S&T)

3. SUBTITLE ................................. : Final Report

4. AUTHORITY ............................ : DI-MISC-80711A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : DE JTO 9. DIST. STATEMENT REQUIRED ....... : (See (Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : DD 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : A 11. AS OF DATE ......................................... : None

14. DISTRIBUTION A. ADDRESSEES B. COPIES

Final CRC

COTR 1 1

DE JTO PM’s Office 1 1 AFRL RDKT Lt Lt ACO Lt Lt

15.TOTAL: 2 2

THE REPORT WILL BE PUBLISHED WITH THE DEFENSE TECHNICAL INFORMATION CENTER (DTIC) BY DE JTO. Under no circumstances shall the contractor deliver either the draft or the final technical report to DTIC.

Block 4: GUIDANCE FOR PREPARATION OF THE REPORT: The Scientific and Technical Report shall be prepared I.A.W. best practices on format and scholarly content. Incomplete reports will be immediately returned to the contractor. Following DE JTO technical and STINFO reviews, any revisions required will be returned to the contractor.

The contractor shall deliver two editable electronic copies of the report. The electronic copies shall be an editable .pdf file and the most current version of Microsoft Word. A CD- ROM (CD-R) is the acceptable media for submittal (CD-RWs are not acceptable). Electronic media shall be marked I.A.W. the AFRL ANSI/NISO Standard Z39.18-2005 guidelines, or other most current report preparation guidance. Submission via unencrypted or unsecure email is not permitted.

Block 7: UPON NOTIFICATION OF ACCEPTANCE OF THE SCIENTIFIC AND TECHNICAL REPORT FROM THE PROGRAM OFFICE, the contractor shall deliver the final Receiving Report (DD Form 250) in WAWF. In preparing the final DD Form 250, code the shipment number with a “Z.” Do not upload the Scientific and Technical Report into WAWF or DTIC. NOTE: SUBMITTAL OF THE DD FORM 250Z PRIOR TO ACCEPTANCE NOTIFICATION WILL RESULT IN REJECTION OF THE DD FORM

250Z FINAL RECEIVING REPORT.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD 5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

Distribution Statement B if containing Proprietary Information:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (MARK ONLY ON PAGES THAT CONTAIN PROPRIETARY DATA AND MAKE A NOTE ON TITLE PAGE)

Or the Distribution Statement C if containing no proprietary information:

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT THAT IS NOT MARKED BY

ANOTHER DISTRIBUTION STATMENT.)

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

Blocks 10 - 13: The contractor shall deliver the Final Scientific and Technical Report, in draft, no later than the date specified in the Schedule, CLIN 0002. The DE JTO will review, edit and return the draft no later than the date specified in the Schedule, CLIN 0002. Upon receipt of the reviewed and edited draft, the contractor shall deliver the final version of the report no later than the date specified in the Schedule, CLIN 0002.

Block 14: The contractor shall distribute the Scientific and Technical Report (final/CRC version(s)) in accordance with Block 14A. When the addressee’s copy is identified by “Lt”, send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18.ESTIMATED TOTAL PRICE:

G. PREPARED BY: Diana Loree I. APPROVED BY:

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 3 of 6 pages

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. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0005

C. CATEGORY .............................. : OTHER F. CONTRACTOR ...... :

1. DATA ITEM NO. ...................... : A004

2. TITLE OF DATA ITEM ........... : Developmental Design Drawings and Associated Lists

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-SESS-81002F (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : DE JTO 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : None

14. DISTRIBUTION A. ADDRESSEES B. COPIES

DRAFT FINAL

COTR 1

DE JTO PM’s Office 1

15.TOTAL: 2

Block 4: Paragraph 3. Format. Developmental Design Drawings/Models and Associated Lists shall be in the contractor's format. Tailoring will be specified in the task order/contract.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD 5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

Distribution Statement B if containing Proprietary Information:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (MARK ONLY ON PAGES THAT CONTAIN

PROPRIETARY DATA AND MAKE A NOTE ON TITLE PAGE)

Or the Distribution Statement C if containing no proprietary information:

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT THAT IS NOT MARKED BY ANOTHER DISTRIBUTION STATMENT.)

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

Block 10, 12 and 13: As required by Procurement Contracting Officer (PCO) approved Contract/Task Order.

Block 14: Deliver an electronic version (Microsoft format) on CD-R or via other appropriate electronic means. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18.ESTIMATED TOTAL PRICE:

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 4 of 6 pages

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. : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0005

C. CATEGORY .............................. : OTHER F. CONTRACTOR ...... :

1. DATA ITEM NO. ...................... : A005

2. TITLE OF DATA ITEM ........... : Test Plan

3. SUBTITLE ................................. : N/A

4. AUTHORITY ............................ : DI-NDTI-80566A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : DE JTO 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ............................... : Lt 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ................................. : 11. AS OF DATE ......................................... : None

14. DISTRIBUTION A. ADDRESSEES B. COPIES

DRAFT FINAL

COTR 1

DE JTO PM’s Office 1

15.TOTAL: 2

Block 4: The test plan (with attached appendices for safety, security, transportation, etc, as needed) shall be written IAW the template provided by the DE JTO as specified in each task order/ contract.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD 5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

Distribution Statement B if containing Proprietary Information:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (MARK ONLY ON PAGES THAT CONTAIN

PROPRIETARY DATA AND MAKE A NOTE ON TITLE PAGE)

Or the Distribution Statement C if containing no proprietary information:

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT THAT IS NOT MARKED BY ANOTHER DISTRIBUTION STATMENT.)

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

Block 10, 12 and 13: The document will be delivered 30 calendar days before the start of a major experiment or demonstration to the PM and COTR.

When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee. The document needs to be generated only once per Task, unless testing parameters or type change.

Block 14: Deliver an electronic version on CD, DVD ROM or other appropriate electronic means. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18.ESTIMATED TOTAL PRICE:

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 5 of 6 pages

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. .... : 0002 D. SYSTEM/ITEM : Modeling and Effects Open BAA B. EXHIBIT .................................... : A E. CONTRACT/PR NO. : FA9451-18-S-0005

C. CATEGORY .............................. : OTHER F. CONTRACTOR :

1. DATA ITEM NO. ...................... : A006

2. TITLE OF DATA ITEM ........... : Physical Inventories Report

3. SUBTITLE ................................. : Contractor Acquired Property (CAP)

4. AUTHORITY ............................ : DI-MGMT-80259 (http://www.assistdocs.com)

5. CONTRACT REFERENCE ..... : : Will be addressed at the task order/award level

6. REQUIRING OFFICE .............. : DE JTO 9. DIST. STATEMENT REQUIRED ...... : (See Block 16) 12. DATE OF FIRST SUBMISSION: N/A

7. DD 250 REQ ............................... : Lt 10. FREQUENCY ...................................... : Annually 13. DATE OF SUBSEQUENT SUBM.: Annually

8. APP CODE ................................. : 11. AS OF DATE ........................................ : N/A

14. DISTRIBUTION A. ADDRESSEES B. COPIES

DRAFT FINAL

COTR 1

DE JTO PM’s Office 1

AFRL RDKT 1

ACO 1

15. TOTAL: 4

Block 4: The list shall be prepared according to the remarks below.

During performance of this Contract/Task Order the contractor may purchase material or equipment using government funds (Contractor Acquired Property (CAP)) as specified in the Task Order/ contract. The contractor shall annually perform, record, and disclose physical inventory results of all CAP material/equipment. Ninety (90) days prior to Task Order/ contract expiration the contractor shall deliver a final CAP Property List suitable for close-out purposes containing use/disposition recommendations and approved by the Contract Program Manager or the DCMA Property Administrator.

The CAP Property List shall include:

-List of CAP by nomenclature -National Stock Number of each equipment- CAP meeting IUID criteria of DFARS 211.274-2 -Serial number of each equipment -Quantity of each equipment -Condition of each equipment, in accordance with the equipment condition status listed:

--Service Usable without qualification. New, used, repaired, or reconditioned.

--Service Usable with qualification. New, used, repaired or reconditioned equipment which is serviceable and useable for its intended purposes but which is restricted for issue to specific units, activities, or geographical areas by reason of its limited usefulness or short service life expectancy.

--Serviceable Test/Modifications. Serviceable equipment which requires test, alteration, modification, conversion or disassembly.

-Status of the CAP -Solutions of problems relating to the above -Request assistance for repair of CAP, as necessary.

The CAP property List shall be delivered in a spreadsheet using Microsoft Office Excel. Abbreviations are not allowed.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD 5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

Distribution Statement B if containing Proprietary Information:

"Distribution authorized to US government agencies; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (MARK ONLY ON PAGES THAT CONTAIN PROPRIETARY DATA AND MAKE A NOTE ON TITLE PAGE)

Or the Distribution Statement C if containing no proprietary information:

"Distribution authorized to US government agencies and their contractors; Critical Technology; (date of submittal). Other requests for this document shall be referred to DE JTO, 801 University Blvd SE, Suite 209, Albuquerque, NM 87106.

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. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT THAT IS NOT MARKED BY

ANOTHER DISTRIBUTION STATMENT.)

All technical data (including electronic media) shall be marked with the following statement: “DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.”

Block14: Deliver an electronic version (Microsoft format) on CD-ROM (CD-R) or via other appropriate electronic means. When the addressee’s copy is identified by “Lt,” send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18. ESTIMATED TOTAL PRICE:

G. PREPARED BY: Diana Loree I. APPROVED BY:

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 6 of 6 pages