FOUO C04.08- Exhibit A - YT-802 CDLRs (Portfolio).pdf

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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

1_DATA_ITEM_NO: A015

2_TITLE_OF_DATA_ITEM: ZINC ANODE LOCATION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82108

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.3.6

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: N/A

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report a minimum of 4 working days prior to an undocking event.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-10-02T12:27:56-0700

BESAW.DONALD.C.1294627711

2020-10-06T07:01:58-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

Source: https://assist.dla.mil -- Downloaded: 2016-02-24T13:38Z Check the source to verify that this is the current version before use.

DATA ITEM DESCRIPTION

Title: STRUCTURAL INSPECTION REPORT

Number: DI-MGMT-82065

AMSC Number: N9714

DTIC Applicable: No

Preparing Activity: SH

Applicable Forms: N/A

Approval Date: 20161003

Limitation: N/A

GIDEP Applicable: No

Project Number: MGMT-2016-052

Use/Relationship: This DID will report the conditions found during structural inspection of each exposed piping penetration, deck drain, deck plating and bulkheads for structural integrity, deterioration, pitting, cracks, and areas of damage or distortion.

This DID contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

Requirements:

1. Format. The report shall be in the contractor’s format.

2. Content. The report shall contain the following information:

a. Name and Hull number of ship

b. Job Order

c. Work Item

d. Paragraph numbers including standard item paragraph number

e. Compartment (number and name)

f. Date of inspection

g. Material condition

h. Deficiencies noted

i. Recommendation for repairs

End of DI-MGMT-82065

Source: https://assist.dla.mil -- Downloaded: 2016-10-13T13:23Z

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

1_DATA_ITEM_NO: A016

2_TITLE_OF_DATA_ITEM: STRUCTURAL INSPECTION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82065*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.5

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 4:

Use/Relationship Block: After the phrase "found during", delete "structural".

Use/Relationship Block: After the phrase "inspection of", delete "each exposed piping penetration, deck drain, deck plating and bulkheads for".

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-10-02T12:30:35-0700

BESAW.DONALD.C.1294627711

2020-10-06T07:03:02-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

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

1_DATA_ITEM_NO: A028

2_TITLE_OF_DATA_ITEM: CERTIFICATION/DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-80678*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.7.2.3.3.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 4:

Preparation Instructions Block: Delete paragraphs 10.1, 10.2.2, 10.2.3, 10.2.4.

Paragraph 10.2.1, Delete after the word Objective evidence, "may", Delete after the words "such items as", spectrographs, radiographs, material sampling, analysis"

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection and test.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-10-02T13:33:41-0700

BESAW.DONALD.C.1294627711

2020-10-06T07:29:55-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

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

1_DATA_ITEM_NO: A001

2_TITLE_OF_DATA_ITEM: Contractor's Progress, Status and Management Report

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-80227*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.5.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: WEKLY*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 4: Paragraph 10.2: Delete "This report shall be typewritten on standard size (e.g. 8 1/2" by 11'") white paper, and securely stapled.".

Delete Paragraphs 10.3.d; 10.3.g; 10.3.i; 10.3.j; 10.3.k; 10.3.l.

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13:

Submit first report 5 working days prior to project start date.

Submit report 24 hours prior to each weekly scheduled production meeting.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-10-02T11:05:57-0700

BESAW.DONALD.C.1294627711

2020-10-06T06:32:45-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

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

1_DATA_ITEM_NO: A029

2_TITLE_OF_DATA_ITEM: CERTIFICATION/DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-80678*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.7.2.3.3.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 4:

Preparation Instructions Block: Delete paragraphs 10.1, 10.2.2, 10.2.3, 10.2.4.

Paragraph 10.2.1, Delete after the word Objective evidence, "may", Delete after the words "such items as", spectrographs, radiographs, material sampling, analysis"

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection and test.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-10-02T13:34:36-0700

BESAW.DONALD.C.1294627711

2020-10-06T07:30:45-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

Source: https://assist.dla.mil -- Downloaded: 2016-05-07T22:28Z

Source: https://assist.dla.mil -- Downloaded: 2016-05-07T22:28Z

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

1_DATA_ITEM_NO: A030

2_TITLE_OF_DATA_ITEM: CERTIFICATION/DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-80678*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.7.3.3

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

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draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 4:

Preparation Instructions Block: Delete paragraphs 10.1, 10.2.2, 10.2.3, 10.2.4.

Paragraph 10.2.1, Delete after the word Objective evidence, "may", Delete after the words "such items as", spectrographs, radiographs, material sampling, analysis"

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection and test.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-10-02T13:35:53-0700

BESAW.DONALD.C.1294627711

2020-10-06T07:32:00-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

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

1_DATA_ITEM_NO: A002

2_TITLE_OF_DATA_ITEM: COATING SYSTEM DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-QCIC-82111

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.5.5

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: N/A

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

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addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10 and 12: Report shall be submitted 5 business days after contract award.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: QCIC

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-10-02T11:20:53-0700

BESAW.DONALD.C.1294627711

2020-10-06T06:42:26-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

Title: COATING SYSTEM DATA REPORT

Number: DI-QCIC-82111 Approval Date: 20170327

AMSC Number: N9784 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: QCIC-2017-004

Use/Relationship: Coating System data report is used by the Government to define product requirements.

The Website cited in this DID can be accessed at: http://www.nstcenter.biz/tech-documents/astm-f718s/

1. References Documents. The applicable issue of the documents cited herein, including their approval dates and dates of any applicable amendments, notices, and revisions, shall be as specified in the contract.

2. Format. The Report shall be in contractor’s format.

3. Content. The Report shall include all of the information specified in The American Society of Testing and Materials, Standard Specification for Shipbuilders and Marine Paints and

Coatings Product/Procedure Data Sheet(ASTM) F-718.

End of DI-QCIC-82111

Source: https://assist.dla.mil -- Downloaded: 2017-03-28T14:42Z http://www.nstcenter.biz/tech-documents/astm-f718s/ http://www.nstcenter.biz/tech-documents/astm-f718s/

Title: SAFETY DATA SHEET (SDS) REPORT

Number: DI-SAFT-82112 Approval Date: 20170327

AMSC Number: N9785 Limitation: N/A

Preparing Activity: SH Project Number: SAFT-2017-004

Use/Relationship: The SDS Report will be used by the Government to define product safety and environmental procedures.

The Website cited in this DID can be accessed at:

https://www.osha.gov/Publications/OSHA3514.html

1. References.

1.1 Occupational Safety and Health Administration (OSHA) Part Number 1910.1200 App D

SDS, Subpart Z Toxic and Hazardous Substances.

2. Format. The Report shall be in contractor’s format.

3. Content. The Report shall include all of the information specified in the Occupational

Safety and Health Administration (OSHA) Part Number 1910.1200 App D SDS, Subpart Z

Toxic and Hazardous Substances.

End of DI-SAFT-82112

Source: https://assist.dla.mil -- Downloaded: 2017-03-28T14:43Z https://www.osha.gov/Publications/OSHA3514.html

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

1_DATA_ITEM_NO: A031

2_TITLE_OF_DATA_ITEM: CERTIFICATION/DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-80678*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.7.3.4

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

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draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 4:

Preparation Instructions Block: Delete paragraphs 10.1, 10.2.2, 10.2.3, 10.2.4.

Paragraph 10.2.1, Delete after the word Objective evidence, "may", Delete after the words "such items as", spectrographs, radiographs, material sampling, analysis"

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection and test.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-10-02T13:37:05-0700

BESAW.DONALD.C.1294627711

2020-10-06T07:33:07-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

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

1_DATA_ITEM_NO: A003

2_TITLE_OF_DATA_ITEM: SAFETY DATA SHEET (SDS) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-SAFT-82112

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.5.6

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: N/A

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

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reg38x:

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total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10 and 12: Report shall be submitted 5 business days after contract award.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: SAFT

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

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2020-10-02T11:30:09-0700

BESAW.DONALD.C.1294627711

2020-10-06T06:43:56-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

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

1_DATA_ITEM_NO: A004

2_TITLE_OF_DATA_ITEM: CONDITION FOUND REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-81648*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.11

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 4: Delete paragraph 3.2.a.

Paragraph 3.2.b delete "Premium/Acceleration" and "premium".

Paragraph 3.2.c delete "internal milestones" and "and contract".

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 5 working days of work item requirement discovery.

Submit report within 24 hours of anticipated difficulty in meeting contract requirements and/or schedule dates.

For required reports that could result in a change in work to be accomplished or additional material to be procured, submit the required report in a time frame to allow the CO, via the COR, to initiate early action, but no later than the first 20 percent of the scheduled availability.

Drydock related inspection reports shall be submitted no later than the first 20 percent of the scheduled docking period. Drydock related reports which contain readings (final, thickness, etc.) clearances, alignments, test results, or other such data for work that has to be completed prior to pre-flood/undocking, shall be submitted to the CO, via the COR, within 24 hours after recording the data but no later than 72 hours prior to pre-flood/undocking, whichever occurs first.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

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2020-10-02T11:31:47-0700

BESAW.DONALD.C.1294627711

2020-10-06T06:45:50-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

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

1_DATA_ITEM_NO: A032

2_TITLE_OF_DATA_ITEM: CERTIFICATION/DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-80678*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.7.3.5

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 4:

Preparation Instructions Block: Delete paragraphs 10.1, 10.2.2, 10.2.3, 10.2.4.

Paragraph 10.2.1, Delete after the word Objective evidence, "may", Delete after the words "such items as", spectrographs, radiographs, material sampling, analysis"

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection and test.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 10-2-2020

1_APPROVED_BY:

J_DATE: 10/6/20

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0003

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: YT-802

E_CONTRACTPR_NO: N4523A21R1051

FCONTRACTOR: TBD

of_pages: 1

Reset:

2020-10-02T13:40:15-0700

BESAW.DONALD.C.1294627711

2020-10-06T07:34:29-0700

STUBBLEFIELD.MATTHEW.COR.1166829778

Title: CONDITION FOUND REPORT

Number: DI-MGMT-81648 Approval Date: 20040809 AMSC Number: N7531 Limitation: N/A DTIC Applicable: N/A GIDEP Applicable: N/A Office of Primary Responsibility: N PEO SHIPS-FL32 Applicable Forms: N/A

Use/Relationship: The Condition Found Report identifies needed repairs and recommends corrective action for work discovered during the contract performance period which are not covered by the work specifications.

This DID contains the format, content, and intended use information for the data product resulting from the work task described in the contract.

Requirements:

1. Reference documents. N/A.

2. Format. The report shall be in contractor’s format.

3. Content. The report shall be serialized by CFR Number, and shall include the following:

a. Contract number, ship and hull number

b. Work Item Number to which the CFR relates

c. Date work requirement was discovered

d. Clear description of the work requirement

e. Specific location of the work requirement

f. Recommendation for corrective action

3.1 Recommendation for appropriate/best time to accomplish (i.e. during current availability with or without schedule change, future CNO or Continuous Maintenance Availability), and supporting rationale for the recommendation (such as cost efficiencies, availability of work force, availability of material, premium expenditures, etc.).

3.2 Cost and time estimates and the time frame for which it is valid, including:

a. Class “C” cost estimates. For work requirements which could be estimated within five working days, a class “F” estimate (+/-40%) identifying any potential impact which may affect the current schedule shall be included. The Class “F” estimate shall also contain the date on which a class “C” estimate will be provided.

b. Estimated Premium/Acceleration Costs, including premium costs for; material, subcontractors, man-hours, rework and any additional costs to on going work resulting from inclusion of the CFR work requirement.

c. Identification of related changes, if any, to the internal milestones and production and contract completion dates shall be included. When no changes were required a statement to that fact shall also be included

4. Media. The electronic media requirements shall be as specified in the contract on the DD 1423 CDRL.

5. End of DI-MGMT-81648

Source: https://assist.dla.mil -- Downloaded: 2016-05-07T22:47Z

DATA ITEM DESCRIPTION

Title: INCIDENT REPORT

Number: DI-MGMT-82071

AMSC Number: N9720

Project Number: MGMT-2016-058

Use/Relationship: This DID will be used to describe each accident, electrical shock, and fire that requires medical treatment.

This DID contains the format and content preparation instructions for the data product generated by the discrete task requirement as delineated in the contract.

Format. The report shall be similar to that of Figure 1.

Content. The report shall contain all the information contained in Figure 1.

Source: https://assist.dla.mil -- Downloaded: 2017-01-05T15:48Z

DI-MGMT-82071

Figure 1

INCIDENT REPORT

Report #

INITIAL REPORT REQUESTED UPDATE FINAL REPORT

TYPE OF INCIDENT:

NAME(S) OF INJURED (if applicable):

INCIDENT DATE: TIME: COMPANY:

SUPERVISOR:

LOCATION OF INCIDENT: TYPE OF INJURY OR FIRE:

CAUSE OF INCIDENT: EQUIPMENT INVOLVED:

WORK ITEM NUMBER: CONTRACT NUMBER:

WITNESS AND/OR INDIVIDUALS INVOLVED

NAME(S) DEPT. COMPANY

DESCRIPTION OF INCIDENT

INVESTIGATED BY (NAME): TITLE:

SIGNATURE OF INVESTIGATOR: DATE:

DISPOSITION OF INJURED (if applicable)

IMMEDIATE CORRECTIVE ACTION

FIGURE 1 (continued)

LONG TERM CORRECTIVE ACTION

INVESTIGATED BY (NAME): TITLE:

SIGNATURE OF INVESTIGATOR: DATE:

INCIDENT REPORT

Report #

ROOT CAUSE ANALYSIS

FIGURE 1 (continued) Incident Report Instructions

REPORT NUMBER- Unique tracking number created by contractor

TYPE OF INCIDENT- Injury, fire or near miss

NAME(S) OF INJURED- Self Explanatory

INCIDENT DATE: - Self Explanatory

TIME: - Self Explanatory

COMPANY: - Prime and subcontractors involved

SUPERVISOR – Supervisor of employee(s) involved

LOCATION OF INCIDENT: - Base/Yard, Ship name and hull number, space number and compartment name TYPE OF

INJURY OR FIRE – i.e. broken arm, laceration to head or Class A, B, C fires, smoldering

CAUSE OF INJURY – i.e. Equipment failure, PPE, process

EQUIPMENT INVOLVED – Equipment working on and equipment being used to cause incident WORK

ITEM NUMBER – Work Item being accomplished when incident occurred

CONTRACT NUMBER: - Contract Number assigned by government agency i.e. RMC, Alteration Installation Team

(AIT) Sponsor.

WITNESS AND/OR INDIVIDUALS INVOLVED – Name, company of witnesses and or individuals involved with the incident.

DESCRIPTON OF INCIDENT OR NEAR MISS – Short description of events leading up to incident and extent of injuries and or damage to equipment.

DISPOSITION OF INJURED – i.e. Transported to hospital via ambulance or POV, transported to clinic, released from hospital, name of…