ExhibitA_Adm_Svc_CDRLs_Blank.pdf

C O N T R A C T D A T A R E Q U I R E M E N T S L I S T (1 Data Item)

Form Approved 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 this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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 E. CONTRACT/PR NO. F. CONTRACTOR

Agency-Wide Administrative Services Support

1. DATA ITEM NO. 2. TITLE OF DATA 3. SUBTITLE

CDRL # Closeout Funds Available for Deobligation Report and Final Invoice

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

Contractor Format with COR approval PWS Paragraph ___ DTRA/J____

7. DD250 REQ

NO

9. DIST

STATEMENT

REQUIRED

10. FREQUENCY

5 Times

12. DATE OF FIRST SUBMISSION

90 DAEO Base Period

14. DISTRIBUTION

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT SUBMISSION a. ADDRESSEE Draft Final

N/A N/A End of Contract and Option(s)

90 DAEO Each Option Reg Report

16. REMARKS Firm Fixed Price Contract/Task Order

DAEO – Days After End Of

Contractor format is acceptable with COR approval.

Not later than 90 days after the expiration of the Base period of performance and expiration of each exercised option period of performance the contractor shall submit a Closeout Funds Available for Deobligation Report and Final Invoice.

The Closeout Funds Available for Deobligation report must contain:

Contractor name and contact information of the preparer of the report; Contract number; Contract type; Amount of funds on this contract by fiscal year of funds and by ACRN; Amount expended by ACRN; Total funds remaining on each ACRN that are not required and can be deobligated.

Deliver report electronically in Microsoft Office Suite Software compatible format by email to:

Program Manager (PM) – Insert Name, email address, phone # Contracting Officer’s Representative (COR) – Insert Name, email address, phone # Contracting Officer (KO) – Insert Name, email address, phone # Contract Specialist (CS) - Insert Name, email address, phone #

Contract Closeout: Closeout @dtra.mil

J4____ PM 1

J4____ COR 1

J4CB_ CS 1

J4CB_ KO 1

Contract Closeout

15. TOTAL 5

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

Preparer’s Name and signature Approver’s Name and Signature

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page _#___ of _#__ Pages

May 19, 2014 mailto:rachel.cole@dtra.mil mailto:roger.white@dtra.mil

CONTRACT DATA REQUIREMENTS LIST

Form Approved 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 thus burden estimate or any other aspect of this collection o f information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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 E. CONTRACT/PR NO. F. CONTRACTOR

Agency-Wide Administrative Services Support

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE

GROUP

CDRL # Financial and Man-Hours Expenditure Report

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

Contractor Format with COR approval PWS/SOO/SOW Para (Choose 1) DTRA/J____

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

No Monthly 5 WDA EO first Month after contract award

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRAFT FINAL

N/A N/A End of Month 5 WDA EO Month Reg Report

16. REMARKS

COST/T& M/LABOR HOUR CONTRACT/TASK ORDER

J_____ PM

WDA – Working days after EO – End of

The cover page or beginning of the first page shall include the Contract #, Contractor Name, CDRL #, Date, Dates of the period the report covers, Name and Phone Number of the Preparer.

The contractor shall provide a monthly Financial Information and Man-Hours Expenditure Report not later than 5 days after the end of each month, beginning after the end of the first Calendar month of the contract order. The Financial information shall include total hours expended for the month by labor categories and ACRN, and total hours used to date by labor categories and ACRN. Financial information shall include amount and percentage of funds used, by labor categories and ACRN; invoice/voucher number, date, amount, payment received/or not received, cumulative payments received to date, any issues related to payment, and steps taken to resolve the problem.

This report shall be provided electronically as an email attachment to the following:

J___ Program Manager (PM) – Insert Name, email address, phone # J___ Contracting Officer’s Representative (COR) - Insert Name, email address, phone # J4CB Division Chief – Insert Name, email address J4CB_ Contracting Officer KO – Insert Name, email address J4CB Contract Specialist CS – Insert Name, email address, phone #

J_____ COR 1

J4CB Division Chief

J4CB_ KO 1

J4CB_ CS 1

15. Total 4

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

Insert PM or COR Name Insert KO Name DD FORM 1423-1, JUN 90 (EG) Previous editions are obsolete Page # of # Pages

Form Approved 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 thus burden estimate or any other aspect of this collection o f information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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 E. CONTRACT|PR NO. F. CONTRACTOR

Agency-Wide Administrative Services

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE

GROUP

CDRL # Financial Report

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

Contractor Format is acceptable PWS/SOW Para DTRA

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

No N/A Monthly 5 WDA EO first full Month b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRA

FT

FINAL

N/A EOM 5 WDA EO each Month Reg Repr o

16. REMARKS

Firm Fixed Price Contract/Task Order

J_____ PM 1

WDA EO – Working Days After End Of EOM – End of Month

The cover page or beginning of the first page shall include the Contract Number, Task Order #, CDRL #, Contractor Name, Date, Dates of the period the report covers, Name and Phone Number of the Preparer.

The report shall include Financial information to include invoice number, date, amount, payment received/or not received, cumulative payments received to date, any issues related to payment, and steps taken to resolve the problem.

This report shall be provided electronically as an email attachment to the following:

Program Manager (PM) – Insert Name, email address, phone # Contracting Officer’s Representative (COR) - Insert Name, email address, phone BCB Division Chief – Insert Name, email address, phone # BCB Contracting Officer KO – Insert Name, email address BCB Contract Specialist CS – Insert Name, email address, phone #

J_____ COR 1

J4CB Division Chief

J4CB_ KO 1

J4CB_ CS 1

15. Total 5

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

DD FORM 1423-1, JUN 90 (EG) Previous editions are obsolete Page of Pages

SECTION XX– EXHIBIT XX

Form Approved 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 thus burden estimate or any other aspect of this collection o f information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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 E. CONTRACT/PR NO. F. CONTRACTOR

Agency-Wide Administrative Services Support

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17.

PRICE

GROUP

CDRL # Master Government Property List (MGPL) and Physical Inventory

GFP, GFE, GFM, and Contractor Acquired Property

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18.

ESTIMA

TED

TOTAL

PRICE

Government provided format MGPL DTRA/Office

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

N/A REQUIRED Varies see Block 12 See Block 16 b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRAFT FINAL

N/A Award of Contract/Task Order

SEE BLOCK 16 Reg Report

16. REMARKS

BLOCK 12: MGPL upon Contract/Task Order award BLOCK 13: Updated when CAP/GFP is provided or turned in. Physical Inventory Report – Annually at the end of each contract year.

During performance of the Contract, the Contractor may purchase material or equipment using government Funds [Contractor Acquired Property (CAP)] if approved by Contract Officer, or be issued Government Furnished Material/Property/Equipment (GFM/P/E). The Contractor shall provide a Master Government Property List (MGPL) inclusive of all GFM/P/E and CAP.

The Master Government Property List shall include all material/equipment/property provided to the contract, including equipment transferred between projects, broken and obsolete equipment, and items purchased outside the United States. The Master Government Property List shall consist of the following data elements at a minimum: Accountable Contract/Task Order Number, Original Manufacturer’s Name, Item Name, Description/Commercial Use, Original Manufacturer’s Part Number, Model Number, Serial Number, DTRA Asset ID #, Equipment Identification Number Quantity, Task Order to which equipment is assigned, Work Breakdown Schedule (WBS) Project Number, Item Unique Identifier or equivalent, Project Descriptor, Equipment Location, Date Placed in Service, Condition of Property, Status (active, stored, in-transit or waiting disposal), Government Property Type [Government Furnished Equipment (GFE), Government Furnished Material (GFM), Government Furnished Property (GFP), Contractor Acquired Property (CAP)], Unit Acquisition Cost (From Accounting System) and Remarks.

The annual physical inventory report shall be documented in writing and validated/confirmed, via signature, by both the Contractor’s Property Administrator and the DTRA’s Government Representative.

Inventory discrepancies must be reported immediately to the Contracting Officer, Contracting Officer Representative/Program Manager or DTRA Accountable Property Officer. The report shall contain original signatures with spreadsheet attachments and be delivered electronically in the attached formatted spreadsheet using Microsoft Office Excel.

Ninety (90) days prior to Contract expiration, the Contractor shall submit a final Master Government Equipment List suitable for close-out purposes containing use/disposition recommendations.

Abbreviations are not allowed.

For recipients, see attached list.

DTRA/J4LCC 1

DTRA/J8CKI 1

DTRA/COR 1

DTRA/J4CB__ 1

15. Total 4

G. PREPARED BY

PM Name and Signature Insert Name

H. DATE I. APPROVED BY

Approving Official Signature Insert Name

J. DATE

DD FORM 1423-1, JUN 90 (EG) Previous editions are obsolete Page X of X Pages

SECTION XX– EXHIBIT XX

Contract Data Requirement List (CDRL) Supplement

Distribution Addresses:

CDRL ADDRESS LIST

DTRA/J4LLCC 8725 John J Kingman Road Fort Belvoir, VA 22060-6201 franklin.garrett@dtra.mil

DTRA/J8CKI 8725 John J Kingman Road Fort Belvoir, VA 22060-6201 J8C-BFKRInbox@dtra.mil

DTRA/ DTRA/J4CB_ 8725 John J Kingman Road Fort Belvoir, VA 22060-6201 Insert CS Name@dtra.mil

DTRA/J____ 8725 John J Kingman Road Fort Belvoir, VA 22060-6201 Insert COR name@dtra.mil

Form Approved 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 thus burden estimate or any other aspect of this collection o f information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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 E. CONTRACT/PR NO. F. CONTRACTOR

Agency-Wide Administrative Services Support

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE

GROUP

CDRL # Payment History Report

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

Contractor Format with COR approval PWS/SOO/SOW Para (Choose 1) DTRA/J____

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION

60 days after the end of

14. DISTRIBUTION

No 1X ea yr the first Contract year b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRAFT FINAL

N/A N/A 60 Days after the end of each Contract Year

60 Days after the end of each contract year.

Reg Report

16. REMARKS

1. Include the Contract #, Task Order Number, Contractor Name, CDRL #, Date, the Report Period Dates, Name, Phone Number and email of the Preparer on the cover page or the beginning of the first page.

2. Provide a Payment History Report not later than 60 days after the end of each contract year that includes all invoice/voucher numbers, date of invoice/voucher, amount billed by CLIN and ACRN and payment amount & date received by CLIN and ACRN for the contract year and cumulative from date of award to the end of the current year.

3. Provide the Payment History Reports electronically as an email attachment to the following:

J___ Program Manager (PM) – Insert Name, email address, phone # J___ Contracting Officer’s Representative (COR) - Insert Name, email address, phone # J4CB Division Chief – Insert Name, email address J4CB_ Contracting Officer (KO) – Insert Name, email address J4CB Contract Specialist (CS) – Insert Name, email address, phone # Contract Closeout: Closeout @dtra.mil

J_____ PM 1

J_____ COR 1

J4CB Division Chief

J4CB_ KO 1

J4CB_ CS 1

Contract Closeout

15. Total 6

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

DD FORM 1423-1, JUN 90 (EG) Previous editions are obsolete Page # of # Pages

Form Approved 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 thus burden estimate or any other aspect of this collection o f information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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 E. CONTRACT|PR NO. F. CONTRACTOR

Agency-Wide Administrative Services Support

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE

GROUP

CDRL # Status and Progress

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

Contractor Format with COR approval PWS/SOW Para

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

No N/A Monthly 5 WDA EO first full Month

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRAFT FINAL

N/A EOM 5 WDA EO each Month Reg Report

16. REMARKS J_____ PM 1

WDA = Working Days After EO = End of EOM = End of Month

The cover page or beginning of the first page shall include the Contract Number Contractor Name, CDRL #, Date, Dates of the period the report covers, Name and Phone Number of the Preparer.

The report shall provide status, progress and include any major problems on any projects in work, address corrective actions taken and/or approach to resolve issues with follow-up status of resolution and shall describe any significant accomplishment and/or difficulties during the reporting period.

The report shall provide status of all deliverables and dates of delivery. Provide this information on a spreadsheet with the title of each deliverable, date due, date delivered, delivery address, and if the deliverable is late, provide an explanation, and corrective action for avoiding late delivery.

This report shall be provided electronically as an email attachment to the following:

Program Manager (PM) – Name, email@dtra.mil Contracting Officer’s Representative (COR) Name, email@dtra.mil, phone # BCB Contracting Officer KO – (KO) Name, email@dtra.mil BCB Contract Specialist CS – Name, email@dtra.mil, phone #

J_____ COR 1

J4CB Division Chief

J4CB_ KO 1

J4CB_ CS 1

15. Total 4

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

PM Name and Approving Official Signature

DD FORM 1423-1, JUN 90 (EG) Previous editions are obsolete Page __ of __ Pages mailto:email@dtra.mil mailto:email@dtra.mil

NO