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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

DATA ITEM DESCRIPTION

Title: Accidertflncident Report

Number DI-SAFT-8 1563 Approved Date: 2 Jun 98 AMSC Numbec A7315 Limitation:

DT3C Applicable: GIDEP Application:

Office of Primary Respomibility A/AR Applicable Fornw Use/relationship: This reportprovides tAeprocuring agency with immediate notification and information concerning any mrjor acciderrthncident (including fire) resulting in any one or more of the following: causing one or more fatalities, or two or snore disabling injuries; damaging government property exceeding $10,000; atTecting program planning or production schedules;

degrading the safety of the equipment under contract, such that persomel injury or property darnage may be involved, identi@ng a potential hazard requiring corrective action.

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

b. This Data Item Description replaces DI-H-I 329A.

Requirements:

1. Format. Contractor format is acceptable

2. Content. Report without delay any serious accident or incident (i.e. explosioq fire, flood pressure rupture, major rndfunction) which will adversely affect capabtity to meet contractual obligations. The report shall be made by the fkstest means, giving the following information.

c.

d.

e.

f.

i.

1.

Name, organization, telephone number, and location of the contractor and general manager Name and title of the person(s) reporting Date and time of accidenthcident Location of accidentiiciden~ i.e., building number, fkcility name Brief summary of accidentkscidcnt giving pertinent details”iircludihgtype ‘md qtiti~”of -materiel Cause of accidentliicident Camalties (fatalities, disabling irjuries, exposed to CBR agents) Estimated property damage, if applicable Nature of darnage; effect on production, operations, training or other activity Action taken by contractor Other damage or injuries sustained (public or private) Other pertinent information

Source: https://assist.dla.mil -- Downloaded: 2016-05-07T21:16Z Check the source to verify that this is the current version before use.

DI-SAFT-81563

3. Malfunction. If a malfunction of equipment is involved, the following additional information shall be finmished:

a. Equipment nomenclature

b. @@ity illvokd

c. Production lot number(s)

d. Brief teehnieal description of malfunction

I 4. End of DI-SAFT-8 1563

Source: https://assist.dla.mil -- Downloaded: 2016-05-07T21:16Z

A005 CDRL Accident & Incident Report

DID DI-SAFT-81563

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: SAFT

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A005

2_TITLE_OF_DATA_ITEM: ACCIDENT/INCIDENT REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-SAFT-81563

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.13.2

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 4: USE/RELATIONSHIP BLOCK: Delete the following: "major"; "one or more fatalities, or two or more disabling"; "exceeding $10,000;".

PARAGRAPH 2.: Delete "serious"; "which will adversely affect capability to meet contractual obligations".

PARAGRAPH 2.G: Delete "disabling"; "exposed to CBR agents".

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: Report shall be submitted within 24 hours of investigation completion.

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: AUG 22, 2016

1_APPROVED_BY:

J_DATE: AUG 22, 2016

Page: 1 of_pages: 1

Reset:

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

Title: TEMPORARY ACCESS CUT DRAWING/SKETCH

Number: DI-PSSS-82079

AMSC Number: N9703

DTIC Applicable: No

Preparing Activity: SH

Applicable Forms: N/A

Approval Date: 20161004

Limitation: N/A

GIDEP Applicable: No

Project Number: PSSS-2016-020

Use/Relationship: This DID will identify each proposed access cut to the ship structure and engine enclosure and a list of each proposed bolted/riveted access removal. The drawing/sketch shall not contain authorized access cuts on NAVSEA-approved drawings.

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.

References. The applicable issue of the documents cited herein, including their approval dates and dates of any applicable amendments, notices, and revisions, shall be as specified in the contract.

Format. The Drawing/Sketch shall be in the contractor’s format.

Content. The Drawing/Sketch shall include the following information:

A plan and elevation view specifying the location of the access by deck, frame, and distance from the center line or deck edge and showing location of adjacent penetrations, bulkheads, framing, welds, and riveted joints within 12 inches of the proposed cut.

Location and number of previous cuts visible in each plate and the cutback of existing welds.

Temporary structural reinforcement required to prevent distortion of ship structure.

Thickness and type of material of plating and structural members to be cut. Include source or document/drawing number which identifies material requirements.

A description of the temporary access closure and enclosures.

A copy of the weld approved weld procedure number with the proposed access sketch.

List of bolted/riveted access covers shall include location, designation, and classification as identified on ship's damage control book.

All drawing titles and numbers (including applicable sub-tier), and technical documentation that will used to accomplish the requirements of MIL-STD-1689.

End of DI-PSSS-82079

Source: https://assist.dla.mil -- Downloaded: 2016-10-21T16:21Z

A006 CDRL Temporary Access Cuts

DI-PSSS-82079-Temp Access Cuts

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A006

2_TITLE_OF_DATA_ITEM: TEMPORARY ACCESS CUT DRAWING/SKETCH

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-PSSS-82079

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.14.5

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: 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 8: Product drawing shall be approved for technical content. Government requires 5 days to review and comment. The contractor has 3 work days after receipt of Government comments to prepare and deliver the final data. Criteria for approval shall be correct content and format.

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 preliminary drawing as the data is generated.

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 21, 2016

1_APPROVED_BY:

J_DATE: OCT 21, 2016

Page: 1 of_pages: 1

Reset:

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

OT-17-20012 dsw

Title: Paint Preservation Appendices Report

Number: OT-17-20012 Approval Date:

AMSC Number: N/A Limitation:N4523A-17-R-0009

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

Office of Primary Responsibility: SH/PNSY Project Number:

Use/Relationship: The Preservation Appendices Report will provide the

Government with evidence of completed preservation operations.

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

This DID is for one time use on solicitation N4523A-17-R-0009 only.

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

3. Content. The Paint Preservation Appendices Report shall contain all the information contained in Samples Figures 1-9.

SAMPLE FIGURE-1

SAMPLE FIGURE-2

SAMPLE FIGURE-3

SAMPLE FIGURE-4

SAMPLE Figure-5

SAMPLE FIGURE-6

SAMPLE FIGURE-7

SAMPLE FIGURE-8

SAMPLEFIGURE-9

End of OT-17-20012. dsw

A007 CDRL Paint Preservation Appendices

OT DID-17-20012 Paint Preservation Appendices

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: QCIC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A007

2_TITLE_OF_DATA_ITEM: PAINT PRESERVATION APPENDICES

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20012

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.16.1

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 BLOCK16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16

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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 documents within 3 working days of completion of the following preservation operations: SSPC SP-1, Surface Profiles, and Top Coat Cure.

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 20, 2016

1_APPROVED_BY:

J_DATE: OCT 20, 2016

Page: 1 of_pages: 1

Reset:

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

DATA ITEM DESCRIPTION (DID)

Title: Deck Preservation Appendices Report

Number: OT-17-20013 dsw Approval Date: 20161021 dsw

Office of Primary Responsibility: SH/PNSY Project Number: N/A

Use/Relationship: The Deck Preservation Appendices Report will provide the

Government with evidence of completed preservation operations.

This DID is for one time use on solicitation N4523A-17-R-0009 only. dsw

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

2. Content. The Deck Preservation Appendices Report shall contain all the information contained in Sample Figures 1 and 2.

SAMPLE FIGURE-1

OT-17-20013 dsw

SAMPLE FIGURE-2

End of OT-17-20013. dsw

A008 CDRL Deck Preservation Appendices

OT DID -17- 20013 Deck Preservation Appendices

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: QCIC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A008

2_TITLE_OF_DATA_ITEM: DECK PRESERVATION APPENDICES

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20013

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.17.1

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 BLOCK16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16

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total_draft: 0 reg38t: 1 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 documents within 3 working days of completion of each preservation operation.

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 20, 2016

1_APPROVED_BY:

J_DATE: OCT 20, 2016

Page: 1 of_pages: 1

Reset:

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

DATA ITEM DESCRIPTION (DID)

Title: Hazardous Waste Report

Number: OT-17-20066 dsw Approval Date: 20161114 dsw

AMSC Number: N/A Limitation: N4523A-17-R-0009

Use/Relationship: The Hazardous Waste Report will identify type, amount, and disposal cost of hazardous waste removed during the period of performance. It will provide the Government with evidence of proper hazardous waste disposal.

product generated by the specific and discrete task requirement as delineated

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

2. Content. The report shall contain:

a. Name of each item.

b. Title of each item.

c. Description of each item.

d. Quantity of each item.

e. Analysis used to identify the hazardous waste.

f. Copies of paid invoices for the disposal of hazardous wastes.

g. Copies of paid receipts for the disposal of hazardous wastes.

End of OT-17-20066. dsw

A009 CDRL Hazardous Waste Report

OT DID 17-20066 Hazardous Waste Report

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A009

2_TITLE_OF_DATA_ITEM: HAZARDOUS WASTE REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20066

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.18.1

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:

addressee2:

draft2:

reg2:

repro2:

addressee3:

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reg38x:

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total_draft: 0 reg38t: 1 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 30 calendar days of project completion.

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: 11/14/2016

1_APPROVED_BY:

J_DATE: NOV 23, 2016

Page: 1 of_pages: 1

Reset:

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

A010 CDRL Weight & Stability Report

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: SESS

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A010

2_TITLE_OF_DATA_ITEM: WEIGHT AND STABILITY REPORT FOR IN- SERVICE SURFACE SHIPS

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-SESS-81404A

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.20

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: 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: 1 reg1: 1 repro1:

addressee2: PSNS & IMF C/242 draft2: 1 reg2: 1 repro2:

addressee3:

draft3:

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total_draft: 2 reg38t: 2 total_repro: 0

16_REMARKS:

BLOCK 4: Paragraph 2.6 delete "from prior reports" and "and impact of future alterations".

BLOCK 8: Product shall be approved for technical content. The Government has 5 work days to review the preliminary draft. The contractor has 3 work days after receipt of Government comments to prepare and deliver the final data. Criteria for approval shall be correct content and format.

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 8 working days prior to each 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: AUG 22, 2016

1_APPROVED_BY:

J_DATE: AUG 22, 2016

Page: 1 of_pages: 1

Reset:

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

Title: Gas Free Program Report

Number: OT-17-20074 dsw Approval Date: 20161114 dsw

Use/Relationship: The Gas Free Program Report will provide the Government with proof of the Contractor’s confined space entry/gas free certification processes, qualified personnel, including sub-contractors.

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

2. Content. The Gas Free Program Report shall contain the following Sections:

2.1 Objective.

2.2 Background.

2.3 Assignment of Responsibility for:

a. Employer

b. Program Manager

c. Entry Supervisors

d. Attendants

e. Rescue Team

f. Entrants/Affected Employees

2.4 Training:

a. Training Frequency

b. General Training

c. specific Training

d. Verification of Training

OT-17-20074 dsw

2.5 Identification of Hazards and Evaluation of Confined Spaces:

a. Survey

b. Hazard Reevaluation

c. Prior to Entry Hazard Assessment

d. Hazard Controls

2.6 Entry Permits:

a. Key Elements of Entry Permits

b. Permit Scope and Duration

2.7 Entry Procedures:

a. Prior to Entry

b. Opening a Confined Space

c. Atmospheric Testing

d. Isolation and Lockout/Tagout Safeguards

e. Ingress/Egress Safeguards

f. Warning Signs and Symbols

2.8 Maintenance of Safe Conditions:

a. Conditions

b. Tests required

2.9 Emergency Response:

a. Emergency Response Plan

b. Retrieval Systems and Methods of Non-Entry Rescue

2.10 Current Roster of the following personnel:

a. Certified National Fire Protection Association (NFPA) Marine Chemists

b. Certified Industrial Hygienists

c. Qualified Competent Persons

End of OT-17-20074. dsw

A011 CDRL Gas Free Program

OT DID 17-20074 Gas Free Program

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A011

2_TITLE_OF_DATA_ITEM: GAS FREE PROGRAM REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-DID-17-20074

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.23.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: WEKLY*

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:

draft2:

reg2:

repro2:

addressee3:

draft3:

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total_draft: 0 reg38t: 1 total_repro: 0

16_REMARKS:

BlOCK 8: Product shall be approved for technical content. Government requires 5 work days to review and comment. Contractor has 3 working days to incorporate comments and send back to the Government.

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: BLOCK 10, 12, and 13: Submit report a minimum of 8 working days prior to the start of contract period of performance.

Submit revised report within 2 work days of a change to the Gas Free Program, Personnel, or Certifications/Qualifications.

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: 11/23/2016

1_APPROVED_BY:

J_DATE: NOV 23, 2016

Page: 1 of_pages: 1

Reset:

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

Title: TEST AND INSPECTION PLAN (TIP)

Number: DI-MGMT-82062

AMSC Number: N9711

Approval Date: 20161003

Project Number: MGMT-2016-049

Use/Relationship: This DID is used to identify all inspections and tests required by zero-tier references and first tier references, as well as symbols (I)(V)(Q) test/inspections and (G) government notification identified in the Work Item, and any additional tests and inspections the contractor deems necessary to substantiate product conformance.

Format. The TIP shall be in the contractor’s format.

Content. The TIP shall include the following information:

Ship’s name/hull number

Work Item number

Work Item Paragraph number

Identification of item/component to be inspected/tested

Standard Item Number

Standard Item Paragraph

Location

Sub-Contractor (if applicable)

Inspection Symbol (I, V, Q, G)

Accept/Reject Criteria

Test Result (Accept or Reject)

Notify Date

Notify Time

Request Date

Request Time

Inspection Date

Name of Person Notified

Name of Government Representative at Inspection

Name of Contractor’s authorized representative who witnessed/performed test.

End of DI-MGMT-82062

Source: https://assist.dla.mil -- Downloaded: 2016-10-13T13:29Z

A012 CDRL Test & Inspection Plan

DI-MGMT-82062 Test & Inspection Plan

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A012

2_TITLE_OF_DATA_ITEM: TEST AND INSPECTION PLAN (TIP)

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82062

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.24.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: A*

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16

addressee1: PSNS & IMF C/411 draft1: 1 reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

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total_draft: 1 reg38t: 1 total_repro: 0

16_REMARKS:

BLOCK 8: Government requires 5 days prior to project start date to review and comment. Contractor has 3 days to incorporate any changes and return to Government.

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 TIP 24 hours prior to each weekly scheduled production meeting.

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 14, 2016

1_APPROVED_BY:

J_DATE: OCT 14, 2016

Page: 1 of_pages: 1

Reset:

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

Title: COMPARTMENT INSPECTION REPORT

Number: DI-MGMT-82063

AMSC Number: N9712

Project Number: MGMT-2016-050

Use/Relationship: This DID will be used to provide results of each compartment inspection, including discrepancies found, and provides objective quality evidence (OQE) for the work accomplished within the compartment.

Format. The report shall be in the contractor’s format.

Content. The report shall contain the following information:

Name and hull number of ship

Job Order

Work Item

Paragraph numbers including standard item paragraph number

Compartment (number and name)

Date of inspection

List of discrepancies and the identity of the Contractor responsibility and Government responsibility

Signature of Contractor representative

Signature of SUPERVISOR

Signature of Commanding Officer’s designated representative

End of DI-MGMT-82063

Source: https://assist.dla.mil -- Downloaded: 2016-10-13T13:27Z

A013 CDRL Compartment Inspection

DI-MGMT-82063 Comp Insp Report

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A013

2_TITLE_OF_DATA_ITEM: COMPARTMENT INSPECTION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82063

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.25.1

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 BLOCK16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

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total_draft: 0 reg38t: 1 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 within 3 working days of completion of each inspection.

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 15, 2016

1_APPROVED_BY:

J_DATE: OCT 15, 2016

Page: 1 of_pages: 1

Reset:

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

Title: COMPARTMENT INSPECTION REPORT

Number: DI-MGMT-82063

AMSC Number: N9712

Project Number: MGMT-2016-050

Use/Relationship: This DID will be used to provide results of each compartment inspection, including discrepancies found, and provides objective quality evidence (OQE) for the work accomplished within the compartment.

Format. The report shall be in the contractor’s format.

Content. The report shall contain the following information:

Name and hull number of ship

Job Order

Work Item

Paragraph numbers including standard item paragraph number

Compartment (number and name)

Date of inspection

List of discrepancies and the identity of the Contractor responsibility and Government responsibility

Signature of Contractor representative

Signature of SUPERVISOR

Signature of Commanding Officer’s designated representative

End of DI-MGMT-82063

Source: https://assist.dla.mil -- Downloaded: 2016-10-13T13:27Z

A014 CDRL Compartment Inspection

DI-MGMT-82063 Comp Insp Report

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-17-R-0009

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A014

2_TITLE_OF_DATA_ITEM: COMPARTMENT INSPECTION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82063

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.25.4

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 BLOCK16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

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total_draft: 0 reg38t: 1 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 within 3 working days of completion of each inspection.

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 15, 2016

1_APPROVED_BY:

J_DATE: OCT 15, 2016

Page: 1 of_pages: 1

Reset:

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

Title: Docking and Undocking Plan

Number: OT-17-20071 dsw Approval Date: 20161114 dsw

Use/Relationship: The plan will provide the Government with planned instructions to safely dock and undock the vessel(s).

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

2. Content. The Plan shall contain the following:

a. Operating Practices.

b. Safety and Security.

c. Special precautions and actions required by the characteristics of the dock, marine railway, and any other docking methods.

d. Pumping/flooding schedule.

e. Specific list, trim, and stability requirements.

f. Set and align docking blocks.

g. A scaled drawing including block size, block spacing, and location of vessel with respect…