N4523A-17-R-0007_CDRLs_and_DIDs_2_of_2.pdf

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DATA ITEM DESCRIPTION (DID)

Title: Bacteriological & Free Available Chlorine

(FAC) Test Report

Number: OT-16-20383 dsw Approval Date:20160929 dsw

AMSC Number: N/A Limitation:N4523A-16-R-0036

DTIC Applicable: N/A GIDEP Applicable: N/A

Office of Primary Responsibility: SH/PNSY

Code 411

Applicable Forms: N/A

Use/Relationship: The Bacteriological and FAC Test Report is used to obtain the information to certify that the potable water is safe for human consumption.

This DID contains the format and content preparation instructions for the data product generated by the discrete task requirements as specified in NAVMED P5010-6, Manual of Naval Preventative Medicine, Chapter 6, Water Supply Afloat.

The Website that NAVMED P5010-6, Manual of Naval Preventative Medicine, Chapter 6, Water Supply Afloat can be accessed at:

http://www.med.navy.mil/directives/Pub/5010-6.pdf

This DID is for one time use on solicitation N4523A-16-R-0036 only.

Requirements:

1. Format. The Report shall be in contractor’s format.

2. Content. The report shall contain the following information:

a. Vessel Name/Number.

b. Contract Number.

c. SOW Paragraph Number.

3. The Report shall include a signed statement that the water is safe for human consumption. It shall also certify that the minimum bacteriological and FAC levels have been met in accordance with the requirements of

NAVMED P5010-6, Manual of Naval Preventative Medicine, Chapter 6, Water

Supply Afloat.

End of OT-16-20383. dsw http://www.med.navy.mil/directives/Pub/5010-6.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP ________ TM _______ OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

1_DATA_ITEM_NO: A019

2_TITLE_OF_DATA_ITEM: AIR TEST REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-16-20382

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.6

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

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A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

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OTHER: QCIC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

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Reset:

2016-10-12T14:49:53-0700

TIEMEYER.JOHN.DAVID.1044537105

2016-10-12T14:50:07-0700

TIEMEYER.JOHN.DAVID.1044537105

Title: Air Test Report

Number:OT-16-20382 dsw Approval Date: 20160929 dsw

Office of Primary Responsibility: SH/PNSY Code 411

Use/Relationship: The report will be used to provide Objective Quality

Evidence (OQE) evidence of the contractor’s Air Test.

This DID contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

This DID is for one time use on solicitation N4523A-16-R-0036 only.dsw

2. Content. The Report shall contain:

a. Air Test result.

b. Recommendation for corrective action in the event of a failed Air Test.

c. Estimated costs, including labor, subcontractors, material, rework, and any additional costs for ongoing work resulting from the inclusion of the proposed work recommended as a result of a failed Air Test.

End of OT-16-20382. Dsw

Page 1 of 1 Page

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A020

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20001

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.5.4

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in

Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

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A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

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TIEMEYER.JOHN.DAVID.1044537105

2016-10-12T14:52:10-0700

TIEMEYER.JOHN.DAVID.1044537105

Title: Structure and Equipment Visual Inspection Report

Number: OT-17-20001 dsw Approval Date: 20161003 dsw

Industrial Management Code 411

Use/Relationship: The report will document the results of Visual Inspections.

It provides the Government with evidence of damage and deterioration of ship’s equipment and structure.

2. Content. The Report shall include the following:

a. Identification of defective (actual and suspect) areas showing signs of cracks, excessive pitting, corrosion, deterioration, damage, distortion, and unusual wear.

b. Identification of specific defect measurements.

c. Identification of specific defect locations in relationship to structural members.

d. Identification of specific measurements from specific reference point locations.

End of OT-17-20001. dsw

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A021

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20001

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.7.3

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in

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TDP:

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DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

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TIEMEYER.JOHN.DAVID.1044537105

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A022

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20001

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.7.4.1.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

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DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in

17_PRICE_GROUP:

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G_PREPARED_BY:

H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

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2016-10-12T14:56:49-0700

TIEMEYER.JOHN.DAVID.1044537105

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A023

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20001

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.8.2.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

of_pages: 1

Reset:

2016-10-12T15:00:23-0700

TIEMEYER.JOHN.DAVID.1044537105

2016-10-12T15:00:51-0700

TIEMEYER.JOHN.DAVID.1044537105

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A024

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20001

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.8.2.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

addressee1: PSNS & IMF C/411 draft1:

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

of_pages: 1

Reset:

2016-10-12T15:02:54-0700

TIEMEYER.JOHN.DAVID.1044537105

2016-10-12T15:03:08-0700

TIEMEYER.JOHN.DAVID.1044537105

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A013

2_TITLE_OF_DATA_ITEM: VESSEL FINAL DOCKING REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-16-20381

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.1.11

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: N/A

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

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total_draft: 0 total_repro: 0

16_REMARKS:

BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10: Submit report within 5 working days of final undocking of the vessel.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Government Docking Observer (GDO) and the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

Page: 1 reg38t: 2

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

of_pages: 1

Reset:

2016-10-12T14:23:31-0700

TIEMEYER.JOHN.DAVID.1044537105

2016-10-12T14:23:49-0700

TIEMEYER.JOHN.DAVID.1044537105

Title: Vessel Final Docking Report

Number: OT-16-20381 dsw Approval Date: 20160929 dsw

Applicable Forms: NAVSEA Forms forms 9997/1 through 9997/5

Use/Relationship: The report will document the results of various vessel drydocking evolutions. It will provide the Government with historical information to be applied to future drydockings.

The NAVSEA forms 9997/1 through 9997/5 can be obtained as specified in the contract.

1. Format. The Report shall be presented on NAVSEA forms 9997/1 through

9997/5.

2. Content. The Report shall contain all the information specified in NAVSEA forms 9997/1 through 9997/5 as applicable to each vessel.

End of OT-16-20381. dsw

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A014

2_TITLE_OF_DATA_ITEM: ZINC ANODE LOCATION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20004

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.2.5.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: N/A

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

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total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report a minimum of 4 working days prior to an undocking event.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

of_pages: 1

Reset:

2016-10-12T14:34:28-0700

TIEMEYER.JOHN.DAVID.1044537105

2016-10-12T14:34:46-0700

TIEMEYER.JOHN.DAVID.1044537105

Title: Zinc Anode Location Report

Number: OT-17-20004 dsw Approval Date: 20161005 dsw

Office of Primary Responsibility: Project Number:

SH/PUGETNSY (Code 400)

Use/Relationship: The report will provide detailed current zinc anode locations of the underwater hull of vessel(s) and will be used by the

Government for future drydock blocking plans.

This DID is for one time use on solicitation N4523A-16-R-0036 only. dsw

1. Format. The Plan shall be in contractor’s format.

2. Content. The Zinc Anode Location Report shall contain a sketch of the underwater body and freeboard plating surfaces with corresponding specific measurements, locations, and relationship to fixed hull structural members and docking block locations, including measurements from suitable hull reference points

End of OT-17-20004. dsw

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A015

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20001

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.5

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

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reg2:

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total_draft: 0 total_repro: 0

16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

of_pages: 1

Reset:

2016-10-12T14:37:10-0700

TIEMEYER.JOHN.DAVID.1044537105

2016-10-12T14:37:27-0700

TIEMEYER.JOHN.DAVID.1044537105

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A016

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20001

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

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H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

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The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A017

2_TITLE_OF_DATA_ITEM: AIR TEST REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-16-20382

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.3

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

addressee1: PSNS & IMF C/411 draft1:

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in

Representative (COR) specified in the contract.

17_PRICE_GROUP:

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H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: QCIC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

of_pages: 1

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TIEMEYER.JOHN.DAVID.1044537105

Title: Air Test Report

Number:OT-16-20382 dsw Approval Date: 20160929 dsw

Office of Primary Responsibility: SH/PNSY Code 411

Use/Relationship: The report will be used to provide Objective Quality

Evidence (OQE) evidence of the contractor’s Air Test.

2. Content. The Report shall contain:

a. Air Test result.

b. Recommendation for corrective action in the event of a failed Air Test.

c. Estimated costs, including labor, subcontractors, material, rework, and any additional costs for ongoing work resulting from the inclusion of the proposed work recommended as a result of a failed Air Test.

End of OT-16-20382. Dsw

Page 1 of 1 Page

The 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 the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for 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

1_DATA_ITEM_NO: A018

2_TITLE_OF_DATA_ITEM: BACTERIOLOGICAL AND FAC REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-16-20383

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.5

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

addressee1: PSNS & IMF C/411 draft1:

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit each report within 2 working days of test.

BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: OCT 12, 2016

1_APPROVED_BY:

J_DATE: OCT 12, 2016

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0036

FCONTRACTOR: TBD

of_pages: 1

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