CDRLS.xlsx

XLSX spreadsheet 182 KB Posted Sep 22, 2016

Attached to: FACSFAC Hardware
Solicitation number: N00421-16-R-0058
Issued by: Department of the Navy Naval Air Systems Command Naval Air Warfare Center

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CDRLs

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File	Type	Posted
N00421-16-R-0058_FACSFAC_Questions_20161102.docx	DOCX document	Nov 2, 2016
N00421-16-R-0058_FACSFAC_RFP_Amendment_2.docx	DOCX document	Nov 2, 2016
N00421-16-R-0058_FACSFAC_Questions_20161012.docx	DOCX document	Oct 21, 2016
N00421-16-R-0058_FACSFAC_Questions_20161012.docx	DOCX document	Oct 18, 2016
N00421-16-R-0058_FACSFAC_RFP_Amendment_1.docx	DOCX document	Oct 18, 2016
N00421-16-R-0058_FACSFAC_Questions_20161012.docx	DOCX document	Oct 12, 2016
PPQ.doc	DOC document	Oct 12, 2016
N00421-16-R-0058_FACSFAC_RFP_Amendment_1.docx	DOCX document	Oct 12, 2016
Cost.xls	XLS spreadsheet	Sep 22, 2016
Data_Transmittal.doc	DOC document	Sep 22, 2016
DD_254.pdf	PDF	Sep 22, 2016
Fully_Burdened_Rate.xls	XLS spreadsheet	Sep 22, 2016
OCI_List.docx	DOCX document	Sep 22, 2016
QASP.doc	DOC document	Sep 22, 2016
WD_05-2104.pdf	PDF	Sep 22, 2016
PPQ.xls	XLS spreadsheet	Sep 22, 2016
N00421-16-R-0058_FACSFAC_RFP.docx	DOCX document	Sep 22, 2016
DRAFT_PWS.doc	DOC document	Feb 9, 2016
Personnel_Qualifications.docx	DOCX document	Feb 9, 2016
Draft_Labor_Categories_and_Labor_Hours.xlsx	XLSX spreadsheet	Feb 9, 2016
DRAFT_CDRLS.xlsx	XLSX spreadsheet	Feb 9, 2016

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A001

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other ______X_________
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A001	RETURN ITEM FORM					FACSFAC REPAIR FACILITY RETURN ITEM FORM
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
SEE BLOCK 16			PBWS Sow Para: 3.1.1.2, 3.1.5.1				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		See Block 16		See Block 16
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
A		See Block 16		See Block 16					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 4 -Sample FACSFAC Return Item Form is Attached as Annex (1).

Block 10, 11, 12, & 13 One form shall be completed for every item; All forms shall be available

for Government review on a daily basis. Contractor shall submit forms as deliverable at contract conclusion.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 19

A002

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other MISC
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A002	Certification/Data Report					BEYOND ECONOMICAL REPAIR BER REPORT
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-MISC-80678			PBWS Sow Para: 3.1.5.2				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		ASREQ		See Block 16
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
A		See Block 16		See Block 16					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 8 - This report shall be generated after the contractor has deemed it necessary to make a BER recommendation and shall be delivered within 5 working days of this decision The Government will have 20 working days for review and comment. The Contractor shall have 10 working days to incorporate Government comments. Subsequent Government approval is required 10 working days after incorporation of comments by Contractor.

Block 10, 11, 12 & 13 - The Final Certification/Verification Report is due 20 working days after Certification/Verification

testing is completed.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	2	of	19
1007/183

A003

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other NDTI
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A003	Test Plan					TEST AND QUALITY CONTROL PROCEDURES
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-NDTI-80566A			PBWS Sow Para: 3.1.4.1, 3.1.5.3				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		ASREQ		See Block 16
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		N/A		N/A					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 12 - The report shall be initially delivered 14 days after contract award

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	3	of	19
1007/183

A004

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other Misc
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A004	Inventory/Utilization Report					Inventory List Report
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-MISC-81107A			PBWS Sow Para: 3.2.3.a				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		ANNUALLY		SEE BLOCK 16
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		See Block 16		ANNUALLY					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

CONTRACTORS SHALL PROVIDE AN ANNUAL INVENTORY LISTING IN ACCORDANCE WITH PBWS 3.2 IN THE CONTRACTORS

FORMAT.

Block 11, 12, & 13 - REPORT SUBMITTED EACH YEAR BY 30 OCTOBER AND UPDATES AS REQUESTED.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	4	of	19
1007/183

A005

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
3001		A		TDP_________	TM	Other Misc
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A005	Scientific and Technical Reports					Recommendation Report
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-MISC-80711A			See Block 16				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		ASREQ		ASREQ
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		See Block 16		See Block 16					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 5 - PBWS Sow Para: 3.2.3.b, 3.4.2.c, 3.5.2.a, 3.5.2.e

Block 10, 11, 12 & 13 - Submit in accordance with PBWS SOW 3.2.3.b, 3.4.2.c, 3.5.2.a, 3.5.2.e

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	5	of	19
1007/183

A006

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
3001		A		TDP_________	TM	Other MGMT
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A006	Engineering and Technical Service Accomplishment Report					Trip Report
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-MGMT-80061A			PBWS Sow Para: 3.3.2.a, 3.4.2.a, 3.5.2.c, 6.1.a,				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
LT	REQUIRED							b. COPIES
		See Block 16		See Block 16
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		See Block 16		See Block 16					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 10, 11, 12 & 13 - Due within 10 working days after completion of trip.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	6	of	19
1007/183

A007

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other X
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A007	Fleet Metrics Report					Fleet Metrics Forms
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
CONTRACTOR FORMAT			PBWS Sow Para: 3.3.2.b, 3.5.2.d				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		WEEKLY		See Block 16
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		See Block 16		See Block 16					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 10, 11, 12 & 13 - CONTRACTOR TO SUBMIT WEEKLY STATUS USING FORM PROVIDED BY ANNEX 2

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	7	of	19
1007/183

A008

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other ______X_________
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A008	TEST PLANS AND PROCEDURES					Test Plans & Procedures
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
CONTRACTOR FORMAT			PBWS Sow Para: 3.4.2.b, 3.5.2.b,				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
XX		AS REQ		AS REQ
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
A		AS REQ		AS REQ					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 10, 11, 12 & 13 - Submit in accordance with PBWS Sow Para: 3.4.2.b and 3.5.2.b

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	8	of	19
1007/183

A009

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other DRPR
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A009	Engineering Drawings					Level I/II/III Drawing Revisions
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-DRPR-80651			PBWS Sow Para: 3.5.2.f				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
XX		AS REQ		AS REQ
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
A		AS REQ		AS REQ					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 10, 11, 12 & 13 - ELECTRONIC COPIES SHALL BE MADE AVAILABLE UPON REQUEST.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	9	of	19
1007/183

A010

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other __X____
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A010	Production Program Plan					PRODUCTION PROGRAM PLAN
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
CONTRACTOR FORMAT			PBWS Sow Para: 3.5.2.g				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		AS REQ		AS REQ
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		As REQ		AS REQ					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 10, 11, 12 & 13 - ELECTRONIC COPIES SHALL BE MADE AVAILABLE UPON REQUEST.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	10	of	19
1007/183

A011

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other __X__
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A011	Technical Report - Study/Services					PRODUCTION ACCEPTANCE TEST RESULTS
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
CONTRACTORS FORMAT			PBWS Sow Para: 3.5.2.h				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		AS REQ		AS REQ
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		AS REQ		AS REQ					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 10, 11, 12 & 13

THE CONTRACTOR SHALL PROVIDE PRODUCTION ACCEPTANCE TEST RESULTS IN ACCORDANCE WITH THE PBWS.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	11	of	19
1007/183

A012

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other MGMT
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A012	Maintenance Service Report					EQUIPMENT MAINTENANCE LOG REPORT
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-MGMT-80995A			PBWS Sow Para: 3.6.2.a				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		QRTLY		QRTLY
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		QRTLY		QRTLY					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	12	of	19
1007/183

A013

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other FNCL
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A013	FUNDS & LABOR HOUR EXPENDITURE REPORT					FUNDS EXPENDITURE/VOUCHER RECONCILIATION REPORT
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-FNCL-81537			PBWS Sow Para: 4.0.1, 4.0.2				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		MTHLY		See Block 16
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		See Block 16		See Block 16					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 10, 11, 12 & 13 - Due 10 working days after completion of the previous month.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	13	of	19
1007/183

A014

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other _______X________
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A014	Segregation of Costs & Invoice Requirements					Monthly Fund Expenditure Report
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
See Block 16			PWS Para: 4.0.3, 4.1.2				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
LT	REQUIRED	MTHLY		See Block 16				b. COPIES

8. APP CODE	D	11. AS OF DATE	13. DATE OF SUBSEQUENT SUBMISSION	a. ADDRESSEE	Draft	Final
N/A		See Block 16	See Block 16			Reg	Repro
16. REMARKS				NAWCAD 4.11.7	0	1	0

Block 4: Contractor format in accordance with contract Section H-1: Segregation of Costs and Invoice Requirements (NAVAIR 5552.232-9525, Mar 2011 (Variation))

Blocks 11, 12 & 13: Report shall be submitted concurrently with each invoice to the COR and shall be for the exact dollar amount and period of performance as the invoice.

Block 14: Deliverables to be provided in electronic format (Microsoft 2003 or greater).

Hard copy due only upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8270

17192 Aegis Way

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	14	of	19
1007/183

A014 (Attc 1)

Schedule A - Direct Labor	$ 1.00
Schedule B - Material	$ 2.00
Schedule C - Travel	$ 3.00
Schedule D - Other Direct Charges	$ 4.00
Schedule E - Indirect Charges	$ 5.00
Schedule F- Adjustments	$ 6.00
TOTAL	$ 21.00
Schedule G - Outstanding Commitments	$ 6.00

	Schedule A - Direct Labor
	Employee Identifier			Labor Category		Period Covered
Hours Billed		Cumulative
						Off-Site	On-Site	Burdened Cost**	Hours Billed	Burdened Cost*
	Smith, John A. Jr.			Electrical Tech, Level II		8-12 June	15-17 June	$ 750,000.00	2,000.00	$ 999,925.00
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
								$ - 0	0.00	$ - 0
	TOTAL							$ 750,000.00	2,000.00	$ 999,925.00
	* On-site work is considered to be work performed at a Government installation. Off-site work is work performed at the contractor’s facility.
	Schedule B - Material
	Material charges shall be itemized and shall include the invoice number, date, total amount, company, purchase order number, and description of the item. A copy of the paid invoice shall be made available upon request.
	Invoice Number		Date	Total Amount	Company			PO#	Description
	CV-10987-654-321-A		11/29/15	$ 78,654.32	Whatchamacallit, Inc			123A-4567-89	Frama-stan Widget, WX123

110 M, Black

	Schedule C - Travel
	Travel Charges shall be itemized and shall include the dates of travel, names of individuals traveling, destination, purpose, and total cost. A copy of the travel voucher shall be made available upon request. Copies of back-up receipts need not be submitted; however, they should be retained and are subject to review.
	Date
From - To	Employee Identifier	Location	Purpose	Cost

	06/21/12	Fife, Barney G.	651 Center St
Mayberry, WV 12378		Initial installation of AN/FY-117; Upgrade of Electron Dissembler to Rev 5	$ 2,156.34
	06/25/12

	Schedule D - Other Direct Charges
	Other direct charges shall be itemized. Copies of invoices shall be available upon request. Subcontractor invoices shall be in the same format and require the same detail.
	Tracking / Invoice
Number		Date	Total Amount	Source		Description
	CV-10987-654-321-A		11/29/15	$ 78,654.32	Whatchamacallit, Inc		Frama-stan Widget, WX123

110 M, Black

	Schedule F- Adjustments
	Current fiscal year invoice adjustments shall be shown in this section along with the justification. Adjustments that pertain to prior fiscal years shall be invoiced separately.
	Invoice Number		FY	Base Amount	Adjustment
Plus / (Minus)	Corrected Amount	Description
	1000005859370059		12	$ 78,654.32	$ (15,731.00)	$ 62,923.32	20 Pc, Circuit Cards, Motorola P/N XN-78-9A; Defective - Returned for credit

Attachment 1

A014 (Attc 2)

Schedule E - Indirect Charges
Indirect charges include those charges based upon a rate that is subject to verification by DCAA at contract closeout.
Invoice Number	POP	Total Amount	Labor

Material Other Rate Per Hour /

Unit	Description
	CV-10987-654-321-A		11/29/12
12/14/12	$ 78,654.32	Material	$ 786.55	100 PC	Circuit Cards; Motorola P/N Xn-78-9A; Replentish Bench Stock

Attachment 2

A015

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
3001		A		TDP_________	TM	Other ______X_________
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A015	PROGRESS REPORT

Felps, Delia J CIV: Felps, Delia J CIV:

Do we need a separate CDRL for 75% ???	4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE		6. REQUIRING OFFICE
	CONTRATOR FORMAT			PBWS Sow Para: 4.0.4, 4.1.a		NAWCAD 4.11.7
	7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION	14. DISTRIBUTION
		REQUIRED					b. COPIES
	LT		Monthly		Monthly
	8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION	a. ADDRESSEE	Draft	Final
	N/A		Monthly		Monthly			Reg	Repro
	16. REMARKS					NAWCAD 4.11.7		1	0
	The Contractor shall notify the Government when costs for any one task has reached 75% of the funded amount.

Block 10, 11, 12 & 13 - Report is due 10 working days after completion of each month.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	15	of	19
1007/183

A016

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
3001		A		TDP_________	TM	Other MGMT
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A016	Government Owned Material (GOM) Status Report					Material Tracking Report
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-MGMT-81543			PBWS Sow Para: 4.3				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
LT		See Block 16		45 DAC
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
N/A		See Block 16		See Block 16					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 10 - After initial delivery, report is due 10 days after the beginning quarterly in accordance with PWBS PARA 4.3.

Block 11, 12 & 13 - Due 15 working days after contract award and annually thereafter.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	16	of	19
1007/183

A017

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other MGMT
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A017	Operations Security (OPSEC) Plan					N/A
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-MGMT-80934C (See Block 16)			PBWS Sow Para: 7.0				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
XX (See Block 16)		0TIME		See Block 16
8. APP CODE	C	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
A		See Block 16		See Block 16					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 4 - Delete reference in DI-MGMT-80934C. Instead use the definition of sensitive information given in public law 100-235,

Use National Security Decision Directive (NSDD) 298 for the concept of operations security.

Block 7 - XX Acceptance will be by the COR via the Data Transmittal/Acceptance/Rejection Form. If this form has not been

transmitted within 10 working days of submission of the CDRL, the CDRL is considered accepted.

Block 11, 12 &13 - Preliminary draft plan due 90 DACA. Final due 45 days after Government approval of the draft. Revisions as

required after approval of final plan only to comply with Government data protection policy documents revision.

Block 14 - Electronic Copy shall be made available in Microsoft Office 2010 format or earlier.

Hard copy shall be made available upon request.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	17	of	19
1007/183

A018

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 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		C. CATEGORY:
		A		TDP_________	TM	Other MGMT
D. SYSTEM/ITEM			E. CONTRACT/PR NO.			F. CONTRACTOR
ACS Technical, Engineering Products and Services			N00421-16-R-0058			TBD
1. DATA ITEM NO.	2. TITLE OF DATA ITEM					3. SUBTITLE
A018	Status Report					Information Technology Personnel Security report for COR
4. AUTHORITY (Data Acquisition Document No.)			5. CONTRACT REFERENCE				6. REQUIRING OFFICE
DI-MGMT-80368A (See Block 16)			PBWS Sow Para: 7.0				NAWCAD 4.11.7
7. DD 250 REQ	9.DIST STATEMENT	10. FREQUENCY		12. DATE OF FIRST SUBMISSION			14. DISTRIBUTION
	REQUIRED							b. COPIES
DD		See Block 16		See Block 16
8. APP CODE	D	11. AS OF DATE		13. DATE OF SUBSEQUENT SUBMISSION			a. ADDRESSEE	Draft	Final
A		See Block 16		See Block 16					Reg	Repro
16. REMARKS							NAWCAD 4.11.7		1	0

Block 4: Digital media to be in IBM compatible Microsoft Excel 2000 or later format.

Contractor to submit IT Personnel Security Report for all employees requiring access to Government IT

systems. Ensure that only the following information is included:

User's Last Name; First Name; MI; Suffix; Exact Sigma User Name (if none - leave blank); Employee Type: Civ/Mil/CSS/FN;

Contractor No.; Customer AIR/PMA/PEO Code; Org Hdqtrs/NAWC/NATEC, etc.; Duty Location; Work Email Address;

IA Training Date (verified by transcript); Date of User Signature (SAAR Blk 12); Type of Investigation (SAAR Blk 28);

Date Investigation Finalized (SAAR Blk 28c) -- do not put pending; Highest IT Level (SAAR Blk 28c); Date Security Verified

Clearance/Investigation (SAAR BLK 32); Date COR Signature (SAAR Blk 19); COR Name (SAAR Blk 20); COR Email;

Date rec'd Sigma Customer Support Ctr.; Date System Access Granted & COR Notified; Date System Access No Longer

Required; N-ERP IT System (if appc. Put N-Erp), Other IT System/s (separate by comma's); Company Name.

Block 10 & 11: Update report required within (30) days of gain or loss of employee(s) that have or will access Government IT systems.

Block 12: First report is required (30) days after contract award

Block 13: Subsequent reports due (365) days after contract award

Block 14 - Electronic Encrypted Copy shall be provided.

Block 14 Address:

Department of the Navy

Commander, NAVAIRWARCENACDIV

ATTN: Code 4.11.7. Bldg 8271

17454 Webster Field Road

St. Inigoes, MD 20684-4012

			15. TOTAL	0	1	0
G. PREPARED BY	H. DATE	I. APPROVED BY		J. DATE

DD Form 1423-1, JUN 90	Previous editions are obsolete	Page	18	of	19
1007/183

A019

CONTRACTS DATA REQUIREMENTS LIST						Form Approved
(1 Data Item)						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 Highway,
Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, D.C. 20503. Please DO NOT RETURN your form to

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