II.G_Combined Synopsis Solicitation_Exhibit A.pdf

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items)

Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 220 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:

TBD A TDP TM OTHER MISC

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

Build-to-print Hardware Fabrication PR 1300544453 TBD

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

A001 Certificate of Compliance N/A

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

DI-MISC-81356A SOW Para 4.1 NUWCDIVNPT, Code 349

18 ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14.DISTRIBUTION* See BLK 16

LT REQUIRED ASREQ ASREQ b. COPIES

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

SUBMISSION a. ADDRESSEE Draft Final

N/A See BLK 16 N/A See BLK 16 Reg Repro

16. REMARKS COR, 349 0 1 0

BLK 9: See BLK 16 Addendum.

BLKS 10 and 12/13: Certificate of Compliance shall be delivered concurrent with material delivery.

BLK 14 Media Requirements: The report shall be delivered electronically in Microsoft 2016 format with notification to all addresses.

COR, 349: TBD

PI: To be identified on individual TI 3432 DM: NUWC_NPT_3432DataMgt@navy.mil

PI 0 1 0

3432 DM 0 1 0

15. TOTAL 0 3 0

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

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

18 ESTIMATED

TOTAL PRICE

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

REQUIRED

b. COPIES

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

SUBMISSION a. ADDRESSEE Draft Final

Reg Repro

16. REMARKS

Intentionally Blank

15. TOTAL

DD Form 1423-2, AUG 96 (EG) PREVIOUS EDITION MAY BE USED Page 1 of 2 Pages

DD FORM 1423, CONTRACT DATA REQUIREMENTS LIST

BLOCK 16 ADDENDUM

PR 1300544453

BLOCK 9: The following information is provided in amplification of the Block 9 Distribution Statement shown on each DD FORM 1423.

Distribution Statement paragraphs are in addition to CLASSIFICATION markings of the data.

Distribution Statement D. Distribution authorized to the Department of Defense and U.S. DoD contractors only Critical Technology (17 Apr 2018). Other requests shall be referred to NUWCDIVNPT Code 342

The following 'EXPORT CONTROL WARNING NOTICE' must be used in conjunction with DISTRIBUTION STATEMENTS identified in the CDRL:

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 1423-2, AUG 96 (EG) PREVIOUS EDITION MAY BE USED Page 2 of 2 Pages