Ex_A_161028_-_Signed_CDRLs_M67854-16-R-1122_ECH.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) OMB No. 0704-0188

The public reporting burden for this collection of lnfonnation 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 rompleting and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this colledfon of Information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be a\Wre that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a rollection of Information if it does not display a currently valid OMS 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 I c. CATEGORY:

0009 D TDP - TM -- OTHER _x_

D.SYSTEM/ITEM

I

E. CONTRACT/PR NO. F. CONTRACTOR

ECH

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

A021 CERTIFICATE OF COMPLIANCE FIRST ARTICLE TEST METHODS

4. AUTHORITY (Data Acquisition Document No.) I 5. CONTRACT REFERENCE 6. REQUIRING OFFICE Dl-MISC-81356A SOW para 3.8.1.3 MARCORSYSCOM (PdM ICE)

7. DD 250 REQ 9. DIST 10. FREQUENCY 12. DATE OF 1ST SUBMISSION 14. DISTRIBUTION

LT STATEMENT AS_REQ SEE BLK 16 b. COPIES

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

Reg Re pro

16. REMARKS MCSC:PdMICE

Per SOW paragraph 3.8.1.3, submit Certification of Purchase Description Texturing paragraphs 3.5.8.2.1 or 3.5.8.2.2. only, and include Health, Safety, Toxicity, and Hazardous SEE BLK 16.

Material (PD paragraph 4.22.2). Certification of conformance shall be provided certifying that the design andrnaterials of thl;l_helmet have_n_otchanged since approval of FAT (PD Table VIII, note 2).

BLK 9 - The following information shall be included on the deliverable: DISTRIBUTION STATEMENT D: Distribution authorized to the Department of Defense and U.S. DoD contractors only, Administrative or Operational Use, 14 Apr 2009. Other requests shall be referred to Commander, MARCORSYSCOM (Attn: IWS-ICE) 2200 Lester Street, Quantico, VA 22134-6050.

BLK 12 - Submit with delivery of FAT articles.

BLK 14 - Submit a copy via e-mail to:

kathryn.hurd@usmc.mil, Contract Specialist

/ , 15. TOTAL---------~ 0

/~,P~~B/f 1/ I H.DATE

11·~/~

J. DATE

;{)!/I ft1/'Z 28 October 2016 2.~0d 'lDI~ lio Fo(/n 14.23-1, FEB 2001

PREVIOUS EDITION MAY BE USED Page 1 of 23 Pages f

17. PRICE

GROUP

TOTAL PRICE

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