HIC MARKING CDRL 4.2.2 .doc
DOC document 82 KB Posted
- Attached to
- HIGH INTEGRITY CONTAINER Federal contract opportunity
- Solicitation number
- N4523A23Q4066
About this file
This document contains a Contract Data Requirements List (CDRL) specifying the format and content requirements for a Certificate of Compliance data deliverable under a federal contract. The CDRL requires the contractor to submit certification that all items furnished comply with specifications and contract requirements using a standard format including the contractor's name and address, date, contract number, national stock number, item nomenclature, and signature of authorized personnel. The certification documentation must be submitted through the Wide Area Workflow system and emailed to a Navy address. Accompanying documentation is also required to be submitted with item shipments to a Puget Sound Naval Shipyard receiving office. No pricing or award details are provided in this CDRL template.
The related federal contract opportunity is a solicitation from the Department of the Navy Naval Supply Systems Command seeking offers for a High Integrity Container but does not include additional details such as response date, period of performance, pricing terms, or place of performance.
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Text version
SHIPYARD ENGINEERING AND PLANNING PROCEDURES MANUALADVANCE \D 3.60
ADVANCE \D 9.35
CONTRACT DATA REQUIREMENTS LIST
(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 the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Please DO NOT RETURN your form to either of these address. Send completed form to the Government issuing Contracting Officer for the Contract/PR No. Listed in Block E.
| A. CONTRACT LINE ITEM NO. |
| B. EXHIBIT |
| C. CATEGORY |
| TBD |
| A |
| TDP _______________ TM _____________ Other MISC |
D. SYSTEM/ITEM
FY-2023 HIC PURCHASE
E. CONTRACT/PR NO.
TBD
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A001
2. TITLE OF DATA ITEM
CERTIFICATE OF COMPLIANCE
3. SUBTITLE
MARKING COMPLIANCE
4. AUTHORITY (Data Acquisition Document No.)
DI-MISC-81356A
5. CONTRACT REFERENCE
SOW PARAGRAPH 4.2.2
6. REQUIRING OFFICE
PSNS & IMF C/2305.3
7. DD 250 REQ
DD
9. DIST STATEMENT REQUIRED
D*
10. FREQUENCY
OTIME
12. DATE OF FIRST SUBMISSION
ASREQ*
14. DISTRIBUTION
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT SUBMISSION
SEE BLOCK 16*
A. ADDRESSEE
Final
| Draft |
| Reg |
| Repro |
16. REMARKS
Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only. Administration and operations only, effective 6/22/2023. Other U.S. requests shall be referred to COMNAVSEASYSCOM.
Block 12 – Certification/Data Report documentation shall be submitted via Wide Area Workflow (WAWF) e-Business Suite: Invoice, Receipt, Acceptance, and Property Transfer (iRAPT). iRAPT email notification shall be sent to: PSNS.WAWFQACertifications.FCM@navy.mil upon submission.
Block 13- Certification/Date Report documentation shall also be submitted with the shipment of the material to the delivery address supplied:
CERTIFICATE OF COMPLIANCE DOCUMENTATION SHALL ALSO BE SUBMITTED WITH THE SHIPMENT OF THE MATERIAL TO THE DELIVERY ADDRESS SUPPLIED:
RECEIVING OFFICER BLDG 514, ATTN: CODE C/2305
PUGET SOUND NAVAL SHIPYARD & INTERMEDIATE MAINTENACE FACILITY
1400 FARRAGUT AVE, BREMERTON, WA 98314-5001
| PSNS & IMF C/2305* |
| 0 |
| 1 |
| 0 |
| PSNS & IMF* |
| 0 |
| 1 |
| 0 |
| TOTAL |
| 0 |
| 2 |
| 0 |
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| /s/ Peter J. Morgan, C/980 S.2 |
| 6/22/2023 |
| /s/ Richard J. Balter C/980 S.2 |
| 6/22/2023 |
DD Form 1423-1, JUN 90
Page 1 of 2 Page(s)
S/N 0102-LF-010-5600
For Document no: 3173-V100 / JO# 36NF2-87710-S02 / Item# 800
DATA ITEM DESCRIPTION
Title: Certificate of Compliance
Number DI-MISC-81356A Approval Date: 20071218
AMSC Number: N9036 Limitation: N/A
DTIC Applicable: No GIDEP Applicable: No
Office of Primary Responsibility: NAVICP Code 8741
Applicable Forms: N/A
Use/Relationship: The Certificate of Compliance provides certification from the contractor that the materiel supplied is in full compliance with all contract requirements. This DID contains the format, content, and intended use information for the data deliverable required by the contract.
This DID supersedes DI-MISC-81356.
Requirements:
1. Format. The Certificate of Compliance shall be presented in a format similar to that of
Figure 1.
2. Content. The Certificate of Compliance shall contain:
a. Contractor’s name.
b. Contractor’s address.
c. Contractor’s phone number.
d. Date.
e. Contracting Agency’s name.
f. Contract Number.
g. National Stock Number (NSN).
h. Item nomenclature.
i. A statement certifying that all items furnished on the contract are in full compliance with all specification and contract requirements.
j. Authorized personnel’s signature.
k. Authorized personnel’s printed name and title.
DI-MISC-81356A
From: ______________________
(Contractor’s name)
Address: ______________________
(Contractor’s address)
Phone Number: ________________
(Contractor’s phone number)
Date: ________________
To: _______________
(Contracting Agency)
Contract Number: _______________
National Stock Number: _______________
Item Nomenclature: ___________________
“All items furnished on this contract are in full compliance with all specification and contract requirements.”
(Signature of Authorized Personnel
(Printed Name and Title of Authorized Personnel)
Note: The recording of false, fictitious, or fraudulent statements or entries on this document may be punished as a felony under Federal Statutes.
3. End of DI-MISC-81356A
17. PRICE GROUP
18. ESTIMATED� TOTAL PRICE
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