FD2060-23-30022 CDRL_A004.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 the Department of Defense, Executive Services and Communications 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

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

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

The contractor SHALL NOT generate data in support of an option period/task until recipt of a contract modification that exercises the option period/task and obligates additional funding.

CLIN Exhibit Data Item No. Performance Period 0012 A A004 Base Year Pd 1012 B B004 Ordering Period I 2012 C C004 Ordering Period II 3012 D D004 Ordering Period III 4012 E E004 Ordering Period IV

Block 11 & 13:

The Contractor shall notify the Robins AFB Safety Office telephonically at (478)-222-0043 during duty hours and (478)-926-3567 after hours, within four (4) hour after initial notification of all mishaps or incidents for damage to DoD property (material plus labor) entrusted by this contract and employee injuries as a result of the contract operation. A follow-up (written or e-mail) of this mishap/incident notification shall be sent within three calendar days to the Government Representative, the Procurement Contracting Officer (PCO) or the Administrative Contracting Officer (ACO) (with a copy to program manager), who will forward it to the Safety Office. The information that is not available at the time of the initial notification shall be provided within 20 calendar days after the mishap. Mishap notification shall contain, as a minimum, the following information:

a. Contract, Contract Number, Name and Title of Person(s) Reporting

b. Date, Time and exact location of accident/incident

c. Brief Narrative of accident/incident (Events leading to accident/incident)

d. Cause of accident/incident, if known

e. Estimated cost of accident/incident (material and labor to repair/replace)

f. Impound Authority Name and Phone Number (as applicable)

g. Nomenclature of equipment and personnel involved in accident/incident

h. Corrective actions (taken or proposed)

i. Other pertinent information

Block 14a: Submit to:

Erik Lomas, erik.lomas@us.af.mil Keith King, keith.king@us.af.mil David Larson, david.larson.15@us.af.mil