Exhibit_A_CDRL_M68909-18-Q-7603.pdf

PWS Enclosure (1)

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 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.

TBD

B. EXHIBIT

A

C. CATEGORY:

TDP _ _ TM _ _ OTHER __ MGMT__

D. SYSTEM/ITEM

AVTB Emergency Dive Support

E. CONTRACT/PR NO.

TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

CONTRACTOR’S PROGRESS, STATUS, AND

MANAGEMENT REPORT

3. SUBTITLE

MONTHLY STATUS REPORT

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80227

5. CONTRACT REFERENCE

PWS Para 4.1.1

6. REQUIRING OFFICE

AVTB Operations

7. DD 250 REQ

DD

9. DIST

STATEMENT

D

10. FREQUENCY

Monthly

12. DATE OF 1ST SUBMISSION

See Block 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

See Block 16 Draft Final

Reg Repro

16. REMARKS

Block 4: Contractor format is acceptable.The report shall be delivered in the version of Microsoft Office® Products used by AVTB. The report shall include, at a minimum:

Description of the services provided.

Deliverables completed during the reporting period.

Status of the ongoing efforts.

Personnel who performed the work.

Any technical issues, concerns or problems areas, and planned or recommended solutions for correcting the problem(s).

Block 9: DISTRIBUTION STATEMENT D: Distribution authorized to the Department of Defense and U.S. DoD contractors only; Administrative or Operational Use, 15 November 2017. Other requests shall be referred to Amphibious Vehicle Test Branch (AVTB), Attn:

Supply Officer, BLDG 210536 Kraus Street, Camp Pendleton CA 92055-5217.

Block 12, 13: The draft report shall be delivered on the 6th of each month. The final report shall be delivered on the 10th of each month.

Block 14: Distribution shall be made via electronic mail. All submissions shall be in the current version of Microsoft Office® Products used by AVTB.

COR 1

15. TOTAL --------- 1

G. PREPARED BY

C. Burkhart

H. DATE

15 NOV 2017

I. APPROVED BY

David Sandvold

J. DATE

15 NOV 2017

DD Form 1423-1, FEB 2001 (EG) Previous editions are obsolete Page _1_ of _1_ Pages