A001_Monthly_Status_Report_-_Protocol_v1_(002).pdf

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of 2 Pages

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17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

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 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

A

C. CATEGORY:

TDP TM OTHER X-MISC

D. SYSTEM/ITEM

See CDRL Cover Page

E. CONTRACT/PR NO.

HQ0147-18-R-0007

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Technical Report - Study/Services

3. SUBTITLE

Monthly Status Report

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-80508B

5. CONTRACT REFERENCE

SOW Paragraph(s) 4.2

6. REQUIRING OFFICE

MDA/CS

7. DD 250 REQ

NO

9. DIST STATEMENT

REQUIRED

F

10. FREQUENCY

MTHLY

12. DATE OF FIRST SUBMISSION

30 DAC

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

MTHLY

Draft

Final

Reg Repro

16. REMARKS

Block 4: Format according to attachment to Contract.

The report shall include the following details:

a. Status of required products and services for performance objectives identified in the contract. The contractor shall identify the FTE by CLIN and by labor category that were delivered during the reporting period.

b. Status of Other Direct Costs (ODC). List all ODCs that have been approved by the

Contracting Officer. Include by item(s) the approved amount and the actual cost incurred if the purchase has already been made. Also, show when the item was received or planned to be received. Segregate the current information and the cumulative information for the applicable CLIN.

c. Submit on-site/off-site data in the format provided in the attachment to the contract identifying support for each location identified in the PWS.

d. In order to gather data to access the contractor’s small business participation in accordance with FAR 52.219-8 (Utilization of Small Business Concerns) and 52.219-14

(Limitation on Subcontracting), the contractor shall submit a report in accordance with the

Table in the PWS paragraph 4.1, which provides the actual achievements of small business participation. The report shall be submitted semi-annually during contract performance for the periods ending Mar 31 and Sep 30 of each year for the life of the contract. The reports are due 30 days after the close of each reporting period. A final report shall be submitted

30 days prior to the end of the period of performance of the contract.

e. Submit a Quarterly Self-Assessment on the 15th of the month following the end of each quarter from the beginning of the period of performance in the format provided in the attachment to the contract.

Block 9: Further dissemination only as directed by MDA/CS, Bldg 5222, Martin Rd, Redstone Arsenal, AL 35898 (November 2, 2016) or higher DoD authority.

Distribution Statement F is required to control the release of data in this CDRL due to the fact that it contains contractor performance evaluations, critical technology, proprietary information, or test and evaluation information. While efforts may be partially funded with

BA3 appropriations, the data within this product delivery does not meet the definition of

"Scientific and Technical Information" as detailed in DoDI 3200.12.

(Continued on next page)

MDA/DAC 0 1 0

MDA/COR 0 1 0

MDA/ACOR 0 1 0

MDA/SB 0 1 0

15. TOTAL 0 4 0

G. PREPARED BY

HASE.THOMAS.ALLEN.1383201 Digitally signed by HASE.THOMAS.ALLEN.1383201736

DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=MDA, cn=HASE.THOMAS.ALLEN.1383201736 Date: 2015.03.23 15:37:34 -05'00'

H. DATE

06/06/2018

I. APPROVED BY

TRUUMEES.MARC.1043203 Digitally signed by

TRUUMEES.MARC.1043203122

122 Date: 2018.06.06 15:09:27 -05'00'

J. DATE

06/06/2018

Reset

DD FORM 1423-1, FEB 2001 Page 2 of 2 Pages

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A

C. CATEGORY:

X-MISC

TDP TM OTHER

D. SYSTEM/ITEM

See CDRL Cover Page

E. CONTRACT/PR NO.

HQ0147-18-R-0007

F. CONTRACTOR

TBD

16. REMARKS (Continued)

The Monthly Status Report shall be delivered to the PCO with a copy to the Contracting Officer's Representative (COR), Alternate Contracting

Officer's Representative (ACOR), and Small Business Office (MDA/SB) via electronic means.

Technical data or computer software that is properly included on the data rights assertion list incorporated into the contract and containing "Limited

Rights" or "Restricted Rights" legends as specified in DFARS 252.227-7013 and 252.227-7014 shall not be delivered under or in conjunction with the

CDRL without prior written approval of the Contracting Officer.

Technical data or computer software that is not properly included on a data rights assertion list incorporated into the contract shall NOT be delivered with any restrictive markings.

Technical Data" is defined at DFARS 252.227-7013(a) (15) and means recorded information, regardless of the form or method of the recording, of scientific or technical nature (including computer software documentation). Computer software is defined at DFARS 252.227-7014(a)(4), and means computer programs, source code, source code listings, object code listings, design details, algorithms, processes, flow charts, formulae, and related material that would enable the software to be reproduced, recreated, or recompiled.

Under no circumstance shall technical data or computer software to be delivered under or in conjunction with this CDRL be marked "Proprietary" (or any similar nonconforming marking).

“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 (Title 50 U.S.C., App. 2401 et seq.), as amended. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.”

DD FORM 1423-1 (BACK), FEB 2001

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package;

TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15.

Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort

(production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.