II. G. CDRL(jwc, 20220524, for Solicitation).pdf

DD FORM 1423-2, FEB 2001 Previous editions are obsolete Page 1 of 2

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 110 hrs per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, & 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, 1213 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/ATTACHMENT NO. C. CATEGORY

0001 A TDP: TM: OTHER: MISC

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

JCM-14055

PID N66604-22-SIMACQ-NPT-45-0171

PR 1300996761

TBD

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

A001 CERTIFICATE OF COMPLIANCE AURS Capsule Refurbishment (S/N 263)

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

DI-MISC-81356A SOW 4.3.1 NUWCDIVNPT Code 4512

7. DD250 REQ 9. DIST STATEMENT REQ. 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

D

See Block 16 Once See Block 16 a. ADDRESSEE b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT SUBMISSION DRAFT FINAL

N/A N/A N/A REQ REPRO

16. REMARKS Code 4512 0 1 0

Block 4: Contractor format is acceptable. The Certificate of Compliance shall indicate that all requirements specified in the Statement of Work have been met.

Block 9: See Block 16 Distribution Statement Addendum

Block 12: The contractor shall submit upon the completion of the capsule refurbishment.

15. TOTAL 0 1 0

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

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

7. DD250 REQ 9. DIST STATEMENT REQ. 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

a. ADDRESSEE b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT SUBMISSION DRAFT FINAL

REQ REPRO

16. REMARKS

*********** INTENTIONALLY BLANK ***********

15. TOTAL

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

Robert M. Waleyko 4/4/2022 James W. Coleman 5/24/2022

DD FORM 1423-1, ADDENDUM Page 2 of 2

DD FORM 1423, CONTRACT DATA REQUIREMENTS LIST

BLOCK 16 ADDENDUM

PID N66604-22-SIMACQ-NPT-45-0171

PR 1300996761

BLOCK 9: The following information is specifically included 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 D: Distribution authorized to Department of Defense and U.S. DoD contractors only; Critical

Technology. (Dated when data generated). Other request for this document shall be referred to Naval Undersea

Warfare Center Division, Newport, RI, Code 4512.

The following "EXPORT CONTROL WARNING NOTICE" must be used in conjunction with DISTRIBUTION

STATEMENTS identified in all CDRL Items. 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, as amended, Title 50, U.S.C., App. 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of Dod Directive 5230.25.