Exhibit_A_-_LET_Kit_2_-_CDRLs_and_DIDs_Combined.pdf

PDF 2 MB Posted May 11, 2017

Attached to: 726-Class Logistics Escape Trunk (LET) Kit 2 Maintenance, and LET Cradle Fabrication
Solicitation number: N4523A-17-R-0031
Issued by: Department of the Navy Naval Sea Systems Command

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Exhibit A - CDRLs and DIDs for LET Kit 2 and LET Cradles

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Other files

File	Type	Posted
N4523A-17-R-0031_RFC__5_9JUN2017.pdf	PDF	Jun 9, 2017
J-1_SOW_Class-726_LET_Kit_2_-_June_6,_2017.pdf	PDF	Jun 8, 2017
LET_726_Class_Pictures.zip	ZIP file	Jun 8, 2017
N4523A-17-R-0031_Amendment_0001.pdf	PDF	Jun 8, 2017
N4523A-17-R-0031_Reference_Materials.zip	ZIP file	May 15, 2017
J-3_-_LET_Kit_2_-_5-Way_Breakdown.xls	XLS spreadsheet	May 11, 2017
J-4_-_LET_Kit_2_-_Request_for_Clarification_(RFC)_Form.docx	DOCX document	May 11, 2017
N4523A-17-R-0031_Solicitation_-_LET_Kit_2_and_Cradles.pdf	PDF	May 11, 2017
J-1_-_SOW_Class-726_LET_Kit_2_-_Feb_7_2017.pdf	PDF	May 11, 2017
SOW_LET_726_Kit_2_Draft.pdf	PDF	Apr 24, 2017

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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

0001 A

MGMT

Vessel Repair Services N4523A-17-R-0026 TBD

A001 Production Schedule Report N/A

DI-MGMT-80227 CONTRACT PARAGRAPH 1.5.1 PSNS & IMF C/411

N/A D(SEE BLK16)

WEKLY*

N/A

SEE BLOCK 16

PSNS & IMF C/411 1

0 1 0

BLOCK 4: Paragraph 10.2: Delete "This report shall be typewritten on standard size (e.g. 8 1/2" by 11'") white paper, and securely stapled.".

Delete Paragraphs 10.3.d; 10.3.g; 10.3.i; 10.3.j; 10.3.k; 10.3.l.

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 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.

CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165 Date: 2017.03.24 09:37:32 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 07:44:15 -07'00'

Source: https://assist.dla.mil -- Downloaded: 2016-05-07T22:28Z Check the source to verify that this is the current version before use.

Source: https://assist.dla.mil -- Downloaded: 2016-05-07T22:28Z

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

QCIC

VESSEL REPAIR SERVICES N4523A-17-R-0026 TBD

A002 COATING SYSTEM DATA REPORT N/A

DI-QCIC-82111 SOW PARAGRAPH 1.5.5 PSNS & IMF C/411

N/A D(SEE BLK16)

OTIME

N/A

SEE BLOCK 16

N/A

PSNS & IMF C/411 1

0 1 0

BLOCK 12: Report shall be submitted 5 business days after contract award.

1 1

STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778 Date: 2017.04.06 07:37:00 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 07:44:53 -07'00'

DATA ITEM DESCRIPTION

Title: COATING SYSTEM DATA REPORT

Number: DI-QCIC-82111 Approval Date: 20170327

AMSC Number: N9784 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: QCIC-2017-004

Applicable Forms: N/A

Use/Relationship: Coating System data report is used by the Government to define product requirements.

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.

The Website cited in this DID can be accessed at: http://www.nstcenter.biz/tech-documents/astm-f718s/

Requirements:

1. References Documents. 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.

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

3. Content. The Report shall include all of the information specified in The American Society of Testing and Materials, Standard Specification for Shipbuilders and Marine Paints and

Coatings Product/Procedure Data Sheet(ASTM) F-718.

End of DI-QCIC-82111

Source: https://assist.dla.mil -- Downloaded: 2017-03-28T14:42Z http://www.nstcenter.biz/tech-documents/astm-f718s/ http://www.nstcenter.biz/tech-documents/astm-f718s/

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

SAFT

VESSEL REPAIR SERVICES N4523A-17-R-0026 TBD

A003 SAFETY DATA SHEET (SDS) REPORT N/A

DI-SAFT-82112 SOW PARAGRAPH 1.5.6 PSNS & IMF C/411

N/A D(SEE BLK16)

OTIME

N/A

SEE BLOCK 16

N/A

PSNS & IMF C/411 1

0 1 0

BLOCK 12: Report shall be submitted 5 business days after contract award.

1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165

Date: 2017.03.28 14:09:26 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778 Date: 2017.04.06 07:46:06 -07'00'

Title: SAFETY DATA SHEET (SDS) REPORT

Number: DI-SAFT-82112 Approval Date: 20170327

AMSC Number: N9785 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: SAFT-2017-004

Use/Relationship: The SDS Report will be used by the Government to define product safety and environmental procedures.

The Website cited in this DID can be accessed at:

https://www.osha.gov/Publications/OSHA3514.html

1. References.

1.1 Occupational Safety and Health Administration (OSHA) Part Number 1910.1200 App D

SDS, Subpart Z Toxic and Hazardous Substances.

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

3. Content. The Report shall include all of the information specified in the Occupational

Safety and Health Administration (OSHA) Part Number 1910.1200 App D SDS, Subpart Z

Toxic and Hazardous Substances.

End of DI-SAFT-82112

Source: https://assist.dla.mil -- Downloaded: 2017-03-28T14:43Z https://www.osha.gov/Publications/OSHA3514.html

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

MGMT

Vessel Repair Services N4523A-17-R-0026 TBD

A004 Condition Found Report N/A

DI-MGMT-81648 CONTRACT PARAGRAPH 1.11 PSNS & IMF C/411

N/A D(SEE BLK16)

ASREQ*

N/A

SEE BLOCK 16

PSNS & IMF C/411 1

0 1 0

BLOCK 4: Delete paragraph 3.2.a.

Paragraph 3.2.b delete "Premium/Acceleration" and "premium".

Paragraph 3.2.c delete "internal milestones" and "and contract".

BLOCK 10, 12, and 13: Submit report within 5 working days of work item requirement discovery.

Submit report within 24 hours of anticipated difficulty in meeting contract requirements and/or schedule dates.

For required reports that could result in a change in work to be accomplished or additional material to be procured, submit the required report in a time frame to allow the CO, via the COR, to initiate early action, but no later than the first 20 percent of the scheduled availability.

Drydock related inspection reports shall be submitted no later than the first 20 percent of the scheduled docking period. Drydock related reports which contain readings (final, thickness, etc.) clearances, alignments, test results, or other such data for work that has to be completed prior to pre-flood/undocking, shall be submitted to the CO, via the COR, within 24 hours after recording the data but no later than 72 hours prior to pre-flood/undocking, whichever occurs first.

CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165 Date: 2017.03.24 09:50:44 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 07:46:41 -07'00'

Title: CONDITION FOUND REPORT

Number: DI-MGMT-81648 Approval Date: 20040809 AMSC Number: N7531 Limitation: N/A DTIC Applicable: N/A GIDEP Applicable: N/A Office of Primary Responsibility: N PEO SHIPS-FL32 Applicable Forms: N/A

Use/Relationship: The Condition Found Report identifies needed repairs and recommends corrective action for work discovered during the contract performance period which are not covered by the work specifications.

This DID contains the format, content, and intended use information for the data product resulting from the work task described in the contract.

Requirements:

1. Reference documents. N/A.

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

3. Content. The report shall be serialized by CFR Number, and shall include the following:

a. Contract number, ship and hull number

b. Work Item Number to which the CFR relates

c. Date work requirement was discovered

d. Clear description of the work requirement

e. Specific location of the work requirement

f. Recommendation for corrective action

3.1 Recommendation for appropriate/best time to accomplish (i.e. during current availability with or without schedule change, future CNO or Continuous Maintenance Availability), and supporting rationale for the recommendation (such as cost efficiencies, availability of work force, availability of material, premium expenditures, etc.).

3.2 Cost and time estimates and the time frame for which it is valid, including:

a. Class “C” cost estimates. For work requirements which could be estimated within five working days, a class “F” estimate (+/-40%) identifying any potential impact which may affect the current schedule shall be included. The Class “F” estimate shall also contain the date on which a class “C” estimate will be provided.

b. Estimated Premium/Acceleration Costs, including premium costs for; material, subcontractors, man-hours, rework and any additional costs to on going work resulting from inclusion of the CFR work requirement.

c. Identification of related changes, if any, to the internal milestones and production and contract completion dates shall be included. When no changes were required a statement to that fact shall also be included

4. Media. The electronic media requirements shall be as specified in the contract on the DD 1423 CDRL.

5. End of DI-MGMT-81648

Source: https://assist.dla.mil -- Downloaded: 2016-05-07T22:47Z

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

SAFT

Vessel Repair Services N4523A-17-R-0026 TBD

A005 Accident/Incident Report N/A

DI-SAFT-82071 CONTRACT PARAGRAPH 1.13.2 PSNS & IMF C/411

N/A D(SEE BLK16)

ASREQ*

N/A

SEE BLOCK 16

PSNS & IMF C/411 1

0 1 0

BLOCK 10, 12, and 13: Report shall be submitted within 24 hours of investigation completion.

CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165 Date: 2017.03.24 09:52:22 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 07:47:16 -07'00'

Title: INCIDENT REPORT

Number: DI-MGMT-82071

AMSC Number: N9720

DTIC Applicable: No

Preparing Activity: SH

Applicable Forms: N/A

Approval Date: 20161003

Limitation: N/A

GIDEP Applicable: No

Project Number: MGMT-2016-058

Use/Relationship: This DID will be used to describe each accident, electrical shock, and fire that requires medical treatment.

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

Format. The report shall be similar to that of Figure 1.

Content. The report shall contain all the information contained in Figure 1.

Source: https://assist.dla.mil -- Downloaded: 2017-01-05T15:48Z

DI-MGMT-82071

Figure 1

INCIDENT REPORT

Report #

INITIAL REPORT REQUESTED UPDATE FINAL REPORT

TYPE OF INCIDENT:

NAME(S) OF INJURED (if applicable):

INCIDENT DATE: TIME: COMPANY:

SUPERVISOR:

LOCATION OF INCIDENT: TYPE OF INJURY OR FIRE:

CAUSE OF INCIDENT: EQUIPMENT INVOLVED:

WORK ITEM NUMBER: CONTRACT NUMBER:

WITNESS AND/OR INDIVIDUALS INVOLVED

NAME(S) DEPT. COMPANY

DESCRIPTION OF INCIDENT

INVESTIGATED BY (NAME): TITLE:

SIGNATURE OF INVESTIGATOR: DATE:

DISPOSITION OF INJURED (if applicable)

IMMEDIATE CORRECTIVE ACTION

FIGURE 1 (continued)

LONG TERM CORRECTIVE ACTION

INVESTIGATED BY (NAME): TITLE:

SIGNATURE OF INVESTIGATOR: DATE:

INCIDENT REPORT

Report #

ROOT CAUSE ANALYSIS

FIGURE 1 (continued) Incident Report Instructions

REPORT NUMBER- Unique tracking number created by contractor

TYPE OF INCIDENT- Injury, fire or near miss

NAME(S) OF INJURED- Self Explanatory

INCIDENT DATE: - Self Explanatory

TIME: - Self Explanatory

COMPANY: - Prime and subcontractors involved

SUPERVISOR – Supervisor of employee(s) involved

LOCATION OF INCIDENT: - Base/Yard, Ship name and hull number, space number and compartment name TYPE OF

INJURY OR FIRE – i.e. broken arm, laceration to head or Class A, B, C fires, smoldering

CAUSE OF INJURY – i.e. Equipment failure, PPE, process

EQUIPMENT INVOLVED – Equipment working on and equipment being used to cause incident WORK

ITEM NUMBER – Work Item being accomplished when incident occurred

CONTRACT NUMBER: - Contract Number assigned by government agency i.e. RMC, Alteration Installation Team

(AIT) Sponsor.

WITNESS AND/OR INDIVIDUALS INVOLVED – Name, company of witnesses and or individuals involved with the incident.

DESCRIPTON OF INCIDENT OR NEAR MISS – Short description of events leading up to incident and extent of injuries and or damage to equipment.

DISPOSITION OF INJURED – i.e. Transported to hospital via ambulance or POV, transported to clinic, released from hospital, name of hospital or clinic, limited duty or loss time (if known).

IMMEDIATE CORRECTIVE ACTION – i.e. Scene/space secured, ship notified (who and when), RMC notified (who and when) clean-up of blood, equipment secured fire debris cleaned up.

INVESTIGATED BY – Self Explanatory.

TITLE – Self Explanatory.

SIGNATURE OF INVESTIGATOR – Self Explanatory.

DATE – Self Explanatory.

LONG TERM CORRECTIVE ACTION – What action(s) were taken so that incident does not reoccur, i.e. training, safety stand down or process/policy change?

ROOT CAUSE ANALYSIS – Process by which you will identify the cause or contributing factors of the incident.

Note: Attach additional information as necessary.

End of DI-MGMT-82071

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

MISC

VESSEL REPAIR SERVICES N4523A-17-R-0026 TBD

A006 PAINT PRESERVATION APPENDICES N/A

DI-MISC-82120 SOW PARAGRAPH 1.16.1 PSNS & IMF C/411

N/A D(SEE BLK16)

ASREQ*

N/A

SEE BLOCK16

PSNS & IMF C/411 1

0 1 0

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.

1 1

STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778 Date: 2017.04.18 12:53:41 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.18 12:53:52 -07'00'

Title: PAINT PRESERVATION APPENDICES REPORT

Number: DI-MISC-82120 Approval Date: 20170410

AMSC Number: N9794 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: MISC-2017-006

Use/Relationship: The Preservation Appendices Report will provide the Government with evidence of completed preservation operations.

by the specific and discrete task requirements as delineated in the contract.

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

Content. The Paint Preservation Appendices Report shall contain all the information contained in

Sample Figures 1 through 9.

Source: https://assist.dla.mil -- Downloaded: 2017-04-18T13:08Z

DI-MISC-82120

SAMPLE FIGURE-1

SAMPLE FIGURE-2

SAMPLE FIGURE-3

SAMPLE FIGURE-4

SAMPLE FIGURE-5

SAMPLE FIGURE-6

SAMPLE FIGURE-7

SAMPLE FIGURE-8

End of DI-MISC-82120

SAMPLE FIGURE 9

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

MISC

Vessel Repair Services N4523A-17-R-0026 TBD

A007 Hazardous Waste Report N/A

OT-17-20147 CONTRACT PARAGRAPH 1.17 PSNS & IMF C/411

N/A D(SEE BLK16)

OTIME*

N/A

SEE BLOCK 16

N/A

PSNS & IMF C/411 1

0 1 0

BLOCK 10: Submit report within 30 calendar days of project completion.

STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778 Date: 2017.04.06 09:42:25 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 09:42:50 -07'00'

DATA ITEM DESCRIPTION (DID)

Title: Hazardous Waste Report

Number: OT-17-20147 dsw Approval Date: 20170406 dsw

AMSC Number: N/A Limitation: N4523A-17-R-0026

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

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

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.

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-17-R-0026 only. dsw

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

2. Content. The report shall contain:

a. Name, title, description, and quantity of each item.

b. Analysis used to identify the hazardous waste.

c. A statement identifying each hazardous waste with generator assignment.

d. A statement identifying hazardous waste found to be non-hazardous.

e. A statement identifying hazardous waste that did not exist.

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

End of OT-17-20147. dsw

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

MGMT

Vessel Repair Services N4523A-17-R-0026 TBD

A008 Test and Inspection Plan (TIP) N/A

DI-MGMT-82062 SOW PARAGRAPH 1.23.1 PSNS & IMF C/411

A* D(SEE BLK16)

ASREQ*

N/A

SEE BLOCK16

PSNS & IMF C/411 1 1

1 1 0

BLOCK 4: USE/RELATIONSHIP BLOCK: Delete the following: ", as well as symbols (I)(V)(Q) test/inspections and (G) government notification identified in the Work item,"

REQUIREMENTS BLOCK: Delete the following: "Standard Item Number";

"Standard Item Paragraph"; "Inspection Symbol (I,V,Q,G)"; "Request Date";

"Request Time"; "Name of Government Representative at Inspection"

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 10, 12 and 13:

Submit TIP 24 hours prior to each weekly scheduled production meeting.

CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165 Date: 2017.03.24 09:53:23 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 07:48:11 -07'00'

Title: TEST AND INSPECTION PLAN (TIP)

Number: DI-MGMT-82062

AMSC Number: N9711

DTIC Applicable: No

Preparing Activity: SH

Applicable Forms: N/A

Approval Date: 20161003

Limitation: N/A

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: 2016-12-06T20:05Z

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

MGMT

VESSEL REPAIR SERVICES N4523A-17-R-0026 TBD

A009 Magnetic Particle Test Report N/A

DI-MGMT-82065 SOW PARAGRAPH 3.3.2.23.1 PSNS & IMF C/411

N/A D(SEE BLK16)

ASREQ*

N/A

SEE BLOCK 16

PSNS & IMF C/411 1

0 1 0

BLOCK 4:

Title Block: Delete "Structural".

Use/Relationship Block: After the phrase "found during", delete "structural".

Use/Relationship Block: After the phrase "inspection of", delete "each exposed piping penetration, deck drain, deck plating and bulkheads for".

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

1 1

STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778 Date: 2017.04.06 07:42:48 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 07:43:21 -07'00'

Title: STRUCTURAL INSPECTION REPORT

Number: DI-MGMT-82065

AMSC Number: N9714

DTIC Applicable: No

Preparing Activity: SH

Applicable Forms: N/A

Approval Date: 20161003

Limitation: N/A

Project Number: MGMT-2016-052

Use/Relationship: This DID will report the conditions found during structural inspection of each exposed piping penetration, deck drain, deck plating and bulkheads for structural integrity, deterioration, pitting, cracks, and areas of damage or distortion.

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

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

a. Name and Hull number of ship

b. Job Order

c. Work Item

d. Paragraph numbers including standard item paragraph number

e. Compartment (number and name)

f. Date of inspection

g. Material condition

h. Deficiencies noted

i. Recommendation for repairs

End of DI-MGMT-82065

Source: https://assist.dla.mil -- Downloaded: 2016-10-13T13:23Z

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

NDTI

Vessel Repair Services N4523A-17-R-0026 TBD

A010 Water Test Report N/A

DI-NDTI-82110 SOW PARAGRAPH 3.3.6 PSNS & IMF C/411

N/A D(SEE BLK16)

OTIME

N/A

SEE BLOCK 16

N/A

PSNS & IMF C/411 1

0 1 0

BLOCK 4: Title: Delete the following: "Air".

USE/RELATIONSHIP BLOCK: Delete the following: "Air".

BLOCK 12: Submit each report within 2 working days of test.

CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165 Date: 2017.03.28 14:10:43 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 07:49:34 -07'00'

Title: AIR TEST REPORT

Number: DI-NDTI-82110 Approval Date: 20170327

AMSC Number: N9783 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: NDTI-2017-003

Use/Relationship: The report will be used to provide Objective Quality Evidence (OQE) evidence of the contractor’s Air Test and to evaluate the need for vessel repairs that are not covered by the work specifications.

2. Content. The Report shall contain:

2.1 Test result.

2.2 Recommendation for corrective action.

2.3 Estimated costs, including labor, subcontractors, material, rework, and any additional costs to on-going work resulting from the inclusion of the proposed work.

2.4 Identification of related changes, if any, to production completion dates.

End of DI-NDTI-82110

Source: https://assist.dla.mil -- Downloaded: 2017-03-28T14:41Z

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

MGMT

VESSEL REPAIR SERVICES N4523A-17-R-0026 TBD

A011 Magnetic Particle Test Report N/A

DI-MGMT-82065 SOW PARAGRAPH 3.6.1.1 PSNS & IMF C/411

N/A D(SEE BLK16)

ASREQ*

N/A

SEE BLOCK 16

PSNS & IMF C/411 1

0 1 0

BLOCK 4:

Title Block: Delete "Structural".

Use/Relationship Block: After the phrase "found during", delete "structural".

Use/Relationship Block: After the phrase "inspection of", delete "each exposed piping penetration, deck drain, deck plating and bulkheads for".

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

1 1

STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778 Date: 2017.04.06 07:50:11 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 07:50:56 -07'00'

Title: STRUCTURAL INSPECTION REPORT

Number: DI-MGMT-82065

AMSC Number: N9714

DTIC Applicable: No

Preparing Activity: SH

Applicable Forms: N/A

Approval Date: 20161003

Limitation: N/A

Project Number: MGMT-2016-052

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

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

a. Name and Hull number of ship

b. Job Order

c. Work Item

d. Paragraph numbers including standard item paragraph number

e. Compartment (number and name)

f. Date of inspection

g. Material condition

h. Deficiencies noted

i. Recommendation for repairs

End of DI-MGMT-82065

Source: https://assist.dla.mil -- Downloaded: 2016-10-13T13:23Z

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

NDTI

Vessel Repair Services N4523A-17-R-0026 TBD

A012 Electrical (Insulation) Test Report N/A

DI-NDTI-82110 SOW PARAGRAPH 3.10.3 PSNS & IMF C/411

N/A D(SEE BLK16)

OTIME

N/A

SEE BLOCK 16

N/A

PSNS & IMF C/411 1

0 1 0

BLOCK 4: Title: Delete the following: "Air".

USE/RELATIONSHIP BLOCK: Delete the following: "Air".

BLOCK 12: Submit each report within 2 working days of test.

CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165 Date: 2017.03.28 14:11:19 -07'00' STUBBLEFIELD.MATTHEW.COREY.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COREY.1166829778

Date: 2017.04.06 07:51:41 -07'00'

Title: AIR TEST REPORT

Number: DI-NDTI-82110 Approval Date: 20170327

AMSC Number: N9783 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: NDTI-2017-003

2.1 Test result.

2.2 Recommendation for corrective action.

2.3 Estimated costs, including labor, subcontractors, material, rework, and any additional costs to on-going work resulting from the inclusion of the proposed work.

2.4 Identification of related changes, if any, to production completion dates.

End of DI-NDTI-82110

Source: https://assist.dla.mil -- Downloaded: 2017-03-28T14:41Z

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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

0001 A

QCIC

Vessel Repair Services N4523A-17-R-0026 TBD

A013 House, Cofferdam, Adapter Weight Test Report N/A

OT-17-20145 SOW…

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File details come from the government source that posted it. Updated Nov 14, 2017.