16RGS55_sol_ATT1.pdf

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 Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

A ____TDP ____ TM __X___ OTHER _____ADMIN/MANAGEMENT DATA

D. SYSTEM/ITEM

2M Repair Kits

E. CONTRACT/PR NO.

F. CONTRACTOR

N00164-16-R-GS55

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

A001

Status Report

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE

SOW Para 4.0

6. REQUIRING OFFICE

DI-MGMT-80368A GXST

7. DD 250 REQ 9.DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST

SUBMISSION

14. DISTRIBUTION

LT MONTHLY 30 DAYS ARO

b. COPIES

(e-mail)

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

SUBMISSION

a. ADDRESSEE Draft

Final

N N/A N/A Reg Repro

The following paragraphs are applicable: 2, 3, 3.1, and 3.24.

Deliver to:

Crane_2M@navy.mil

DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited.

DESTRUCTION NOTICE – For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 -19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE

CONTRACT OR PURCHASE ORDER, USE OF GOVERNMENT DOCUMENTATION FOR

COMMERCIAL PURPOSES IS FORBIDDEN.

Crane_2M@navy.mil 1

15. TOTAL

G. PREPARED BY

A. Ganster

H. DATE

1/11/16

I. APPROVED BY

N. Abrams

J. DATE

1/11/16 DD Form 1423-1, 1 Jun 90 page 1 of 1

Bill of Material 2M Hardware KIT P/N HK-2M

Fastenal SKU 93202 ¼”-20 x 5/8” ASTM A574 Hex Drive Zinc Finish 4 EA Alloy Steel Socket Cap Screw

Fastenal SKU 37620 ¼”-20 Grade A Zinc Finish Steel Regular Square Nut 4 EA

Fastenal SKU 33618 ¼” Zinc Finish Medium Split Lock Washer 4 EA

Fastenal SKU 0303195 ½”-13 Thread 5/8” Slot 1-1/4”L x 5/8”H Quarter Turn 6 EA T-Slot Nut

Fastenal SKU 23403 ½”-13 x ¾” ASTM A574 Hex Drive Black Oxide Finish 6 EA Alloy Steel Socket Cap Screw

Fastenal SKU 33625 ½” Plain Finish Medium Lock Washer 6 EA

DISTRIBUTION STATEMENT A. APPROVED FOR PUBLIC RELEASE; DISTRIBUTION IS UNLIMITED.

nathan.heikkinen Typewritten Text Enclosure 1