CDRL_A001.pdf

CONTRACT DATA REQUIREMENTS LIST (CDRL)

(1 Data Item) Form Approved OMB No. 0704-0188

The public reporting burden f or this collection of information is estimated to average 110 hours per response, including the time f or rev iewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and rev iewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions f or reducing the burden, to the Departm ent of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other prov ision of law, no person shall be subject to any penalty f or failing to comply with a collection of information if it does not display a currently valid OMB 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. CONTR AC T LINE ITEM NO. B. EXHIBIT C. CATEGOR Y:

A TDP ____ TM _____ OTHER X - NDTI

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRAC TOR

EX 170 MOD 2 ELECTRIC PRIMERS N00178-15- SELECTED PRIME CONTRACTOR

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

A001 TEST/INSPECTION REPORT COMPONEN T AND ASSEMBLY INSPECTIONS

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIM ATED

TOTAL PRICE

DI-NDTI-80809B SOW PARAGRAPH 3.3.4, 5.2 NSWC DAHLGREN, G21

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

LT REQUIRED SEE BLK 16 SEE BLK 16

a. ADDRESSEE

b. COPIES

8. APP CODE

D (SEE BLK 16)

11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

A N/A SEE BLK 16 Reg Repro

16. REMARKS G21 TPOC (SEE BLK 16) 1 1 0

BLK 8: THE GOVERNMENT HAS 10 BUSINESS DAYS FROM RECEIPT OF DRAFT TO REVIEW AND

COMMENT. THE CONTRACTOR HAS 10 BUSINESS DAYS TO SUBMIT REVISIONS. IF THE

GOVERNMEN T DOES NOT PROVIDE COMMEN TS WITHIN 10 BUSINESS DAYS OF INITIAL

SUBMISSION, THE DELIVERABLE IS CONSIDERED ACCEPTED.

BLK 9: DISTRIBUTION STATMENT D: DISTRIBUTION AUTHORIZED TO DEPARTMEN T OF DEFENSE

AND U.S. DOD CONTRACTORS ONLY (ADMINISTRATIVE OR OPERATIONAL USE) (14 MAY 2015).

OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED TO NAVAL SURFACE WARFARE

CENTER, DAHLGREN DIVISION, 6096 TISDALE ROAD, DAHLGREN, VA, 22448. ATTN: MYRON

THOMAS 540-653-2098 MYRON.THOMAS@NAVY.MIL.

BLKS 10, 12, & 13: THE COMPONENT AND ASSEMBLY INSPECTIONS SHALL ACCOMPANY EACH

SHIPMENT OF AMMUNITION.

BLK 14: ELECTRONIC MEDIA: SUBMIT IN MS OFFICE 2010 APPLICATIONS (OR EARLIER) OR

ADOBE PORTABLE DOCUMEN T FORMAT (PDF) TO THE TECHNICAL POINT OF CONTACT,

MYRON.THOMAS@NAVY.MIL.

15. TOTAL ▬▬▬▬► 1 1 0

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

MYRON THOMAS, G21

PATRICIA A. HONOSKY, DM

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 1 of 2 Pages patricia.honosky Typewritten Text 7/8/2015 patricia.honosky Typewritten Text 7/8/2015