J5_N4523A18R0822_CDRLS-DIDS.pdf

CONTRACT DAT A REQUIREMENTS LIST

( 1 Data Item)

Form Approved OMB No. 0704-0188

The public report ing burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching e xisti ng data sources, gathering and mainta ining 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 , Execut ive Services Directorate (0704-0188) . Res pondents should be aw are that notwithstanding any other provision of law , no person shall be subject to any penalty for fa iling to comply w ith 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. C. CATEGORY:

CLIN OOOx

B. EXHIBIT

A TDP ___ TM __ OTHER x

D.SYSTEM/ITEM

Nuclear Aircraft Carrier Repair

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

I

E. CONTRACT/PR NO.

N4523A- I 8-X-XXXX

AOOl PRODUCTION SCHEDULE

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-82075 1

5. CONTRACT REFERENCE

SOW Para. 3.2

F. CONTRACTOR

TBD

3. SUBTITLE

INTEGRATED PRODUCTION SCHEDULE (JPS)

REPORT

6 . REQUIRING OFFICE

PSNS and IMF

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

ASREQ

REQUIRED

See Blk 16 DD b. COPIES

8. APP CODE D 11 . AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a . ADDRESSEE Final

NIA See Blk16 See Blk 16

16. REMARKS

Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of 7-8-2016) Other requests for this document shall be referred to PSNS and lMF, 1400 Farragut Ave.

Bremerton, WA 98314.

Blocks I 0-13 : Submit Production Schedule NL T 48 hours upon arrival on job site.

Government will review and approve. Provide daily production schedule updates to the Contracting Officer's Representative (COR).

G. PREPARED BY H. DATE I. APPROVED BY

WlLLIAMS.MA TTHEW.SCOTI. l o;p 1a11y li&ncd by

156405864 ~~L~~;'j~~~~~~~~~. llS640Slf64 11/9/2017

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED.

Draft Reg Re pro

C/413 COR

15. TOTAL 0 0

J. DATE

11/9117

Page of Pages Adobe Professional 8.0

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

( 1 Data Item)

A. CONTRACT LINE ITEM NO. I B. EXHIBIT A I c. CATEGORY: x CLIN OOOx TOP __ TM __ OTHER

D. SYSTEM/ITEM IE. CONTRACT/PR NO. IF.CONTRACTOR

Nuclear Aircraft Carrier Repair N4523A-l 8-X-XXXX TBD

16. REMARKS (Continued)

I'

DD FORM 1423-1, FEB 2001 Page __ of Pages

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010. 12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory .

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TOP - Technical Data Package;

TM Technical Manual; Other - other category of data , such as " Provisioning, ""Configuration Management, " etc .

Item D. Enter name of system/item being acquired that data will support .

Item E. Self-explanatory (to be filled in after contract award) .

Item F. Self-explanatory (to be filled in after contract award) .

Item G. Signature of preparer of CORL.

Item H. Date CORL was prepared .

Item I. Signature of CORL approval authority .

Item J. Date CORL was approved.

Item 1. See DoD FAR Supplement Subpart 4 . 71 for proper numbering .

Item 2. Enter title as it appears on data acquisition document cited in Item 4 .

Item 3. Enter subtitle of data item for fu rther definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL) , or one-time DID number, that defines data content and format requirements .

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g ., Statement of Work paragraph number) .

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data , specify requirement for contractor to mark the appropriate distribution statement on the data (ref . DoDD 5230.24) .

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable .

Item 12. Specify when first submittal is required .

Item 13. Specify when subsequent submittals are required , when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/ final copies to be delivered .

Item 16. Use for additional /clarifying information for Items 1 through 15.

Examples are : Tailoring of documents cited in Item 4 ; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14. ; Desired medium for delivery of the data item.

DD FORM 1423-1 (BACK), FEB 2001

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production , development, testing , and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements , and the administration and other expenses related to reproducing and delivering such data items to the Government.

b . Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation , control , or quality of the data item .

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c . Group Ill. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format , frequency of submittal , preparation, control , and quality of the data item .

Estimated Price - Costs to be included under Group Ill are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d . Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item , enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data .

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data , over and above those costs which would otherwise be incurred in performance of the contract if no data were required . The estimated data prices shall not include any amount for rights in data . The Government's right to use the data shall be governed by the pertinent provisions of the contract.

CONTRACT DATA REQUIREMENTS LIST Form Approved ( 1 Data Item) OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response , including the t ime for revie w ing instructions, searching existing data sources, gathering and maintaining the data needed , and completing and reviewing the collection of information . Send comments regard ing th is burden estimate or any other aspect of this collection of information , includ ing suggest ions fo r reduc ing the burden , to the Department of Defense , Executive Serv ices Directorate (0704-0188 ). Respondents should be aw are that notw ithstanding any other prov ision of law, no person shall be subject t o any penalty for fail ing to comply with a collection of information if it does not disp lay a current ly va lid OMB control number. Please do not return your form to the above organization . Send completed form to the Government Issuing Contracting Off icer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

CUN OOOx A TOP TM OTHER x

0. SYSTEM/ITEM IE. CONTRACT/PR NO. F. CONTRACTOR

Nuclear Aircraft Carrier Repair N4523A-l 8-X-XXXX TBD

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

A002 CONDITION FOUND REPORT CON DrTION FOUND REPORT

4 . AUTHORITY (Data A cquisi tion Document No.) 15. CONTRACT REFERENCE 6 . REQUIRING OFFICE

DI-MGMT-81648 SOW Para. 3.10 PSNS and IMF 7 . DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

ASREQ ASREQ DD b. COPIES

8. APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D SUBMISSION Draft NIA SeeBlkl6 SeeBlkl6 Reg Repro

16. REMARKS C/413 COR 1

Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of 7-8-2016) Other requests for this document shall be referred to PSNS and IMF, 1400 Farragut Ave.

Bremerton, WA 983 14.

Blocks 10-13: Submit Condition Found Report(s) within 72 hours, as discovered. If revisions are required, resubmit within 72 hours of notification by the government.

15. TOTAL 0 1 0

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

WILLIAMS.MATTHEW.SCOTT. I Diptallysigncdby 11 /9/201 7 GROVER.WILLIAM.N. 103 3 Oi.,ii.Qy 11..,..i.,. OllOVEA ... 'tLUAM.N.lllJJJIOl'6 1119/17 WILLIAJ\.ts.MATIHEW.SCOTI.I U64051164 :~~.:u=)=·-"'1,...-l/SN. 156405 864 Date: 20 17. 11.09 10:1):07·08'00' JIO I R4

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of Pages Adobe Professional 8.0

17. PRICE GROUP

A. CONTRACT LINE ITEM NO. I B. EXHIBIT A IC. CATEGORY:

CLIN OOOx TOP __ TM __ OTHER x

D. SYSTEM/ITEM IE. CONTRACT/PR NO . IF. CONTRACTOR

Nuclear Aircraft Carrier Repair N4523A- l 8-X-XXXX TBD

16. REMARKS !Continued)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory .

Item B. Self-explanatory.

Item C. Mark (XI appropriate category: TOP - Tec hnical Data Package;

TM - Technical Manual ; Other - other category of data , such as "Provisioning, " "Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support .

Item E. Self-explanatory (to be filled in after contract award) .

Item F. Self-explanatory (to be filled in after contract award) .

Item G. Signature of preparer of CORL.

Item H. Date CORL was prepared.

Item I. Signature of CORL approval authority .

Item J. Date CORL was approved.

Item 1. See DoD FAR Supplement Subpart 4 . 71 for proper numbering.

Item 2 . Enter title as it appears on data acquisition document cited in Item 4 .

Item 3 . Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DIDI number , military specification number, or military standard number listed in DoD 5010. 12-L (AMSDL), or one-time DID number , that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e .g ., Statement of Work paragraph number).

Item 6. Enter technical office responsible fo r ensuring adequacy of the data item .

Item 7 . Specify requirement for inspection /acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item .

Item 9. For technical data , specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24) .

Item 10. Specify number of times data items are to be delivered .

Item 11 . Specify as-of date of data item , when applicable .

Item 12. Specify when first submittal is required .

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423 .

a . Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production , development, testing, and administration) but which is required by DD Form 1423 .

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements , and the administration and other expenses related to reproduc ing and delivering such data items to the Government.

b . Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format , frequency of submittal , preparation, control , or quality of the data item .

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements , and the administrative and other expenses related to reproducing and delivering suc h data item to the Government.

c . Group Ill. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format , frequency of submittal , preparation, control , and quality of the data item .

Estimated Price - Costs to be included under Group Ill are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d . Group IV . Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Item 13. Specify when subsequent submittals are required , when Estimated Price - Group IV items should normally be shown applicable. on the DD Form 1423 at no cost.

Item 14. Enter addressees and number of draft /final copies to be delivered to each addressee . Explain reproduc ible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered .

Item 16. Use for additional /clarifying information for Items 1 through 15 .

Examples are: Tailoring of documents cited in Item 4 ; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

DD FORM 1423-1 (BACK), FEB 2001

Item 18. For each data item , enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data .

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required . The estimated data prices shall not include any

CONTRACT DATA REQUIREMENTS LIST Form Approved

The public reporting burden for th is collection of information is estimated to average 110 hours per response , including the time for reviewing instructions, searching exist ing data sources, gathering and mainta ining the data needed , and completing and reviewing the collection of informat ion. Send comments regarding th is burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for fa iling to comply with a collection of information if it does not display a current ly valid OMB cont rol 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:

CLIN OOOx A TOP TM OTHER x

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

Nuclear Aircraft Carrier Repair N4523A- I 8-X-XXXX TBD

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

A003 OBJECTIVE QUALITY EVIDENCE (OQE) JOrNT rNSPECTION REPORT

4 . AUTHORITY (Data Acquisition Document No .) 15. CONTRACT REFERENCE 6 . REQUIRING OFFICE

DI-QCIC-81891 SOW Para. 3. 13.l PSNS and IMF

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

REQUIRED

ASREQ ASREQ DD b. COPIES

8 . APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a . ADDRESSEE Final

NIA D SUBMISSION Draft SeeBlkl 6 SeeBlkl6 Reg Re pro

16. REMARKS C/4 13 COR l Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of?-8-2016) Other requests for this document shall be referred to PSNS and IMF, 1400 Farragut Ave.

Bremerton, WA 983 14.

Blocks 10-13: Submit Objective Quality Evidence (OQE), Joint Inspection Report as required. Government wi ll approve draft. If revisions are required, submit draft revisions within 3 days of notification by the government.

15. TOTAL 0 1 0

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

WILLIAMS.MA TIHEW.SCOTI. I DiJit.lly.i~by 11 /9/2017 GROVER.WILLIAM.N. I 033 °'li....,. ...... ~GR0\1ill.tllWAMJll.llJ)Jll01M 11/9/17 WILLIAMS.J\.tAlTHEW.SCOTI. 11 5640,1164 =~~~)=·~.~. 156405864 O.tc: 20 17.11 .09 IO: ll:07 ·OllW 1 IOI Rd

DD FORM 1423-1. FEB 2001 PREVIOUS EDITION MAY BE USED . Page of Pages Adobe Professional 8.0

17. PRICE GROUP

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT UNI: ITl:M NO. I B. EXHIBITA I c. CATEGORY: x CLIN OOOx TDP __ TM __ OTHER

D. SYSTEM/ITEM IE. CONTRACT/PR NO . IF. CONTRACTOR

Nuclear Aircraft Carrier Repair N4523A-1 8-X-XXXX TBD

16. REMARKS (Continued)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory .

Item B. Self-explanatory .

Item C. Mark (X) appropriate category: TOP - Technical Data Package;

TM - Technical Manual ; Other - other category of data , such as " Provisioning, " "Configuration Management, " etc .

Item D. Enter name of system/item being acquired that data will support .

Item E. Self-explanatory (to be filled in after contract award) .

Item F. Self-explanatory (to be filled in after contract award) .

Item G. Signature of preparer of CORL.

Item H. Date CORL was prepared.

Item I. Signature of CORL approval authority .

Item J. Date CORL was approved.

Item 1. See DoD FAR Supplement Subpart 4 . 71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry) .

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL) , or one-time DID number, that defines data content and format requirements .

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e .g., Statement of Work paragraph number) .

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item .

Item 9. For technical data , specify requirement for contractor to mark the appropriate distribution statement on the data (ref . DoDD 5230.24) .

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required .

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing , and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements , and the administration and other expenses related to reproducing and delivering such data items to the Government.

b . Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal , preparation , control , or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements , and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c . Group Ill. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation , control, and quality of the data item .

Estimated Price - Costs to be included under Group Ill are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d . Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Item 13. Specify when subsequent submittals are required, when Estimated Price - Group IV items should normally be shown applicable . on the DD Form 1423 at no cost.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered .

Item 16. Use for additional /clarifying information for Items 1 through 15 .

Examples are : Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

DD FORM 1423-1 (BACK). FEB 2001

Item 18. For each data item . enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data .

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required . The estimated data prices shall not include any

CONTRACT DAT A REQUIREMENTS LIST Form Approved

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for review ing instructions , searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regard ing this burden est imate or any other aspect of this collection of information , including suggestions for reducing the burden , to the Department of Defense, Executive Services Directorate (0704-0 188) . Respondents should be aw are that notw ithstanding any other provis ion of law , no person shall be subject to any penalty for fail ing to comply with a collec t ion of inform at ion if it does not display a currently valid OMB control number . Please do not ret urn your form to the above organization . S end 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:

CUN OOOx A TOP TM OTHER x

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

Nuclear Aircraft Carrier Repair N4523A- l 8-X-XXXX TBD

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

A005 COMPLETION REPORT Work Completion Certification Certificate

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

DI-MGMT-82050 SOW Para. 4.6 PSNS and IMF 7 . DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED OTIME ASREQ LT b. COPIES

8 . APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D SUBMISSION Draft NIA SeeBlkl 6 SeeBlkl6 Reg Re pro

16. REMARKS C/413 COR 1

Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of 7-8-2016) Other requests for this document shall be referred to PSNS and IMF, 1400 Farragut Ave.

Bremerton, WA 98314.

Blocks 10-13 : Submit within 5 days of work completion. lfrevisions are required, submit draft revisions within 3 days of notification by the government.

15. TOTAL 0 1 0

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

WILLIAMS.MA 1THEW.SC01T. I o;p1a11y •cnatby 11 /9/2017 GROVER.WILLIAM.N .1033 Dl....,.&pod..,.Gf;O\'&L.-IU.JAMJi.101JJIOl lM 1119/17 WILLL .... MS.MATTHEW.SCOTT.J IS64()jfl6-4 =-~"':'i'.~u=l=·-l'KI,~. 156405864 D• tc: 20 17. ll.09 IO:U :07 -08'00' 310184

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED . Page of Pages Adobe Professional 8.0

17. PRICE GROUP

A. CONTRACT LINE ITEM NO . I B. EXHIBITA I c. CATEGORY: x CLIN OOOx TOP __ TM __ OTHER

D. SYSTEM/ITEM IE. CONTRACT/PR NO. ,F. CONTRACTOR

Nuclear Aircraft Carrier Repair N4523A- l 8-X-XXXX TBD

16. REMARKS (Contin ued)

FOR GOVERNMENT PERSONNEL

Item A . Self-explanatory .

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TOP - Technical Data Package;

TM - Technical Manual ; Other - other category of data, such as "Provisioning," "Configuration Management, " etc.

Item D. Enter name of system/item being acquired that data will support .

Item E. Self-explanatory (to be filled in after contract award) .

Item F. Self-explanatory (to be filled in after contract award) .

Item G. Signature of preparer of CORL.

Item H. Date CORL was prepared .

Item I. Signature of CORL approval authority .

Item J. Date CORL was approved.

Item 1. See DoD FAR Supplement Subpart 4 . 71 for proper numbering.

Item 2 . Enter title as it appears on data acquisition document cited in Item 4 .

Item 3. Enter subtitle of data item for further definition of data item (optional entry) .

Item 4. Enter Data Item Description (DID) number , military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements .

Item 5 . Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item .

Item 9. For technical data , specify requirement for contractor to mark the appropriate distribution statement on the data (ref . DoDD 5230.24) .

Item 10. Specify number of times data items are to be delivered .

Item 11. Specify as-of date of data item, when applicable .

Item 12. Specify when f irst submittal is required .

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production , development, testing , and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements , and the administration and other expenses related to reproducing and delivering such data items to the Government.

b . Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of subm ittal, preparation , control, or quality of the data item .

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements , and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c . Group Ill. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content , format , frequency of submittal , preparation, control , and quality of the data item .

Estimated Price - Costs to be included under Group 111 are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Item 13. Specify when subsequent submittals are required , when Estimated Price - Group IV items should normally be shown applicable. on the DD Form 1423 at no cost.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/ final copies to be delivered.

Item 16. Use for additional /clarifying information for Items 1 through 15.

Examples are : Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

DD FORM 1423-1 (BACK). FEB 2001

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data , over and above those costs which would otherwise be incurred in performance of the contract if no data were required . The estimated data prices shall not include any

(1 Data Item)

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 review ing the collection of information . Send comments re garding this burden estimate or any other as pect of th is collection of informat ion, including suggestions for reducing t he burden , to the Department of Defense, Executive Services Directorate (0704-0188) . Respondents should be aw are that notwithstanding any other provision of law , no person sha ll be subject to any penalty for fa iling to comply w ith a collection of information if it does not di s play 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 . li sted in Block E.

A. CONTRACT LINE ITEM NO.

CLIN OOOx

D. SYSTEM/ITEM

B. EXHIBIT

A

C. CATEGORY:

TOP TM

Nuclear Aircraft Carrier Repair I

E. CONTRACT/PR NO.

N4523A-l 8-X-XXXX

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

OTHER x

F. CONTRACTOR

TBD

3. SUBTITLE

A006 CONTRACTOR'S HAZARDOUS MATERIAL INVENTORY CONTRACTOR HAZARDOUS MATERIAL

INVENTORY REPORT

4 . AUTHORITY (Data Acquisition Document No.)

DI-MGMT-82091

5 . CONTRACT REFERENCE

SOW Para. 4.7

6 . REQUIRING OFFICE

PSNS and IMF 7 . DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

OTIME DD ASREQ b. COPIES

Final 8 . APP CODE D 11 . AS OF DATE a. ADDRESSEE Draft NIA SeeBlk16

13. DATE OF SUBSEQUENT

SUBMISSION

SeeBlk1 6 Reg Re pro

16. REMARKS

Block 9: DISTRIBUTION D: Distribution authorized to Department of Defense and US DoD contractors only (administrative or operational use) (As of 7-8-2016) Other requests for this document shall be refe rred to PSNS and IMF, 1400 Farragut Ave.

Bremerton, WA 983 14.

Block I 0: Submit HAZMA T Inventory to C/400 and C/ I 20 ESH rep. within I 5 days of contract award.

Block 11 , 12, and 13 : Submit inventory changes within 15 days of identifying the requirement to add HAZMA T to the initial report.

G. PREPARED BY

WILLIAMS.MATTHEW.SCOTT. I o;p1a11ya~by 156405864 ~~L~~7~J~.~"%~1~S:· l \5640jll6'4

DD FORM 1423-1, FEB 2001

H. DATE

11/9/2017

I. APPROVED BY

GROVER.WILLIAM.N. 1033

3!0184

PREVIOUS EDITION MAY BE USED .

C/413 COR

15. TOTAL 0 0

J . DATE

1119/17

Page of Pages Adobe Professional 8.0

17. PRICE GROUP

1B. ESTIMATED

A. CONTRACT LINE ITEM NO. I B. EXHIBITA IC. CATEGORY: x CUN OOOx TOP __ TM __ OTHER

D. SYSTEM/ITEM I E. CONTRACT/PR NO. IF.CONTRACTOR

Nuclear Ai rcraft Carrier Repair N4523A- 18-X-XXXX TBD

16. REMARKS (Continued)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package;

TM - Technical Manual ; Other - other category of data , such as "Provisioning," "Configuration Management," etc .

Item D. Enter name of system/item being acquired that data will support .

Item E. Self-explanatory (to be filled in after contract award) .

Item F. Self-explanatory (to be filled in after contract award) .

Item G. Signature of preparer of CORL.

Item H. Date CORL was prepared .

Item I. Signature of CORL approval authority .

Item J . Date CORL was approved.

Item 1. See DoD FAR Supplement Subpart 4 . 71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4 .

Item 3. Enter subtitle of data item for further definition of data item (optional entry) .

Item 4 . Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number , that defines data content and format requirements .

Item 5 . Enter reference to tasking in contract that generates requirement for the data item (e.g. , Statement of Work paragraph number) .

Item 6. Enter technical office responsible for ensuring adequacy of the data item .

Item 7. Specify requirement for inspection /acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item .

Item 9. For technical data , specify requirement for contractor to mark the appropriate distribution statement on the data (ref . DoDD 5230.24) .

Item 10. Specify number of times data items are to be delivered .

Item 11. Specify as-of date of data item , when applicable .

Item 12. Specify when first submittal is required .

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423 .

a . Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production , development, testing , and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements , and the administration and other expenses related to reproducing and del ivering such data items to the Government .

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format , frequency of submittal , preparation, control, or quality of the data item .

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements , and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c . Group 111. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format , frequency of submittal , preparation , control , and quality of the data item .

Estimated Price - Costs to be included under Group Ill are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d . Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Item 13. Specify when subsequent submittals are required , when Estimated Price - Group IV items should normally be shown applicable . on the DD Form 1423 at no cost.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/fina l copies to be delivered.

Item 16. Use for additional /clarifying information for Items 1 through 15 .

Examples are : Tailoring of documents cited in Item 4 ; Clarification of submittal dates in Items 12 and 13 ; Explanation of reproducible copies in Item 14. ; Desired medium for delivery of the data item .

DD FORM 1423-1 (BACK), FEB 2001

Item 18. For each data item , enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data , over and above those costs which would otherwise be incurred in performance of the contract if no data were required . The estimated data prices shall not include any

DA TA ITEM DESCRIPTION

Title: INTEGRATED PRODUCTION SCHEDULE (IPS) REPORT

Number: DI-MGMT-82075 AMSC Number: N9726 DTIC Applicable: No Preparing Activity: SH Applicable Forms: NIA

Approval Date: 20161003 Limitation: NIA GIDEP Applicable: No Project Number: MGMT-2016-065

Use/Relationship: This DID will be used for planning, tracking, coordinating and de-conflicting work during the availability. It will also identify all work planned for accomplishment during the maintenance availability.

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.

Requirements:

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 report shall be in the contractor' s format.

Content. The report shall contain all of the information required by Standard Item 009-60 and shall include the following:

IPS shall be in a sortable/filterable spreadsheet.

Critical Path (Gantt) .

Critical Path Network Precedence Diagram Method (PMD).

Key Events/Milestones.

Manpower Curves (Total/Trades) .

Manpower Utilization Report.

Weekly Meeting results.

End of DI-MGMT-82075

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DATA ITEM DESCRIPTION

Title: CONDITION FOUND REPORT

Number: Dl-MGMT-81648 AMSC Number: N7531 DTIC Applicable: N/A Office of Primary Responsibility: N PEO SHIPS-FL32

Approval Date: 20040809 Limitation: N/A GIDEP Applicable: N/A 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 wh ich 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 CORL.

5. End of Dl-MGMT-81648

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Check the source to ve rify that this is the current version before use .

Title: ACCEPTANCE TEST REPORT (ATR) Number: DI-QCIC-81891 AMSC Number: N9313 DTIC Applicable: N/A Office of Primary Responsibility: AS/PMA251 Applicable Forms: NIA

Use/relationship:

Approval Date: 20130118 Limitation: NIA GIDEP Applicable: N/ A

The A TR contains the results of the qualification tests performed by the contractor to demonstrate that the system conforms to the performance specifications, work authorization document, or contract requirements .

This Data Item Description (DID) contains format , content, and intended use information for the data product resulting from the work task described in the Statement of Work (SOW).

Requirements:

I . Format. Contractor' s format is acceptable.

2. Content. The ATR shall contain the following:

a. Test article identification and full description of test specimens utilized, including any deviations for the configuration specified in the applicable test plan.

b. Date and location of test or evaluation.

c. The operator who conducted the test.

d. Results obtained, including specific identification and discussion of objectives demonstrated satisfactorily and those not demonstrated satisfactorily.

e. Contractor' s conclusions, corrective action anticipated, recommendation to correct. deficiencies, and suggested improvements based on evaluation of the test.

f. All analysis and supporting data.

g. All data sheets .

3. End of DI-QCIC-8 1891.

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DI-MGMT-82050

RESULTS/STATUS :

D Complete

D Complete w/ Discrepancies

D Incomplete

Attachment A

Note : If complete with discrepancies or incomplete , rationale and final adjudication must be entered in the Comments block below.

Comments :

Print and Sign Name :

Position and Responsibility :

Date :

3) All required reports and all accompanying required data have been submitted , reviewed , accurate , complete and satisfactory .

RESULTS/STATUS :

D Complete

D Complete w/ Discrepancies

D Incomplete

Note : If complete with discrepancies or incomplete , rationale and final adjudication must be entered in the Comments block below .

Comments :

Print and Sign Name :

Position and Responsibil i ty :

End ofDI-MGMT-82050

Date :

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Title: Work Completion Certification Certificate

Number: DI-MGMT-82050 AMSC Number: N9679 DTIC Applicable: No Preparing Activity: SH Applicable Forms: NIA

Approval Date: 20160705 Limitation: N/ A GIDEP Applicable: No Project Number: MGMT-2016-043

Use/relationship: This DID will certify that all contracted work has been performed and completed.

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.

Requirements:

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

2. Content. The report shall contain all the information specified in Sample Figure 1.

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DI-MGMT-82050

Attachment A Work Completion Certif i cation

SHIP ' S NAME : I HULL NO .:

WORK ITEM NO : I SSP NO . :

KEY EVENT : - Undocking (UD)

Production Completion Date (PCD) -

- Dock Trials (DT )

- Fast Cruise (FC ) Sea Trials - (ST)

- Availability Completion (AC )

- Combat Systems PCD/ALO Other -

1 ) All contracted production work (original , new and growth) has been satisfactorily reviewed , accurate and complete .

RESULTS/STATUS :

D Complete

D Complete w/ Di s crepancies

D Incomplete

Note : If complete with discrepancies or incomplete , rationale and final adjudication must be entered in the Comments block below .

Comments :

Print and Sign Name :

Position and Responsibility :

Date :

2) All Tests and Inspections have been completed satisfactorily reviewed , accurate , complete and properly documented in the T&I Plan .

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Title: CONTRACTOR HAZARDOUS MATERIAL INVENTORY REPORT

Number: DI-ENVR-82091 AMSC Number: N9751 DTIC Applicable: No Preparing Activity: SH Applicable Forms: PSNS&IMF form 5090/132

Approval Date: 20161208 Limitation: N IA GIDEP Applicable: No Project Number: ENVR-2017-001

Use/Relationship: Contractor Hazardous Material Inventory Report will be used to identify hazardous materials needing for approval by the government for use on the Na val Installation.

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

Requirements:

1. Format. The Hazardous Material Inventory Report shall be presented on PSNS&IMF form 5090/132 in this DID.

2. Content. The report shall contain all of the information specified in PSNS&IMF 5090/132.

End of DI-ENVR-82091

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DI-ENVR-82091

Ref: NAVSEA Standard Items 009-97 and

CONTRACTOR HAZARDOUS MATERIAL INVENTORY (CHMI) 009-02 Document No.

NWRMC Local Standard Item 099-04NW

CONTRACTOR - INITIAL REQUEST1 (Before moving any hazmat onto this Federal facility) ** Refer to instructions on last

Page 1of 2 page**

PRIME CONTRACTOR (KTR) (POC) SUB-CONTRACTOR (If Applicable) PRIME KTR CERTIFICATION SIGNATURE (sign or

PHONE

submit electronically) Print & sign

Mr KTR NA Signature on File 555-232- 2222

CONTRACT NUMBER PROJECT NAME2 WORKSITE LOCATION 3 PROJECT EXECUTION START PROJECTED .

N4523A-12-D-0003 USS Michigan Dry Dock 2 12/14/2015 04/03/2016

ENVIRONMENTAL SAFETY. AND HEALTH (ESH) GOVERNMENT REPRESENTATIVE

CONTRACT OFFICE AGENCY (i.e .. C/400. ESH GOVERNMENT REPRESENTATIVE NAME PHONE FAX SUBMITTAL

C/400/106.2 ESH SBS 360-535-2222

CODE 106.31 HAZARDOUS MATERIAL PROCESS MANAGEMENT BRANCH

106.31 NAME & INITIALS RECEIPT DATE REVIEW DATE

Trade Name6 Process

•Name on product & MSDS Manufacturer7 Code SHIPYARD MSDS SHIPYARD Assigned Stock

Number8 Container Size & Type9 Number10 must match

•For kits, list kit name, then list kit components individually

Speclt SSPR 6PK Marking

Fluorescent Green Spray Paint, #1989830

•Name on product & MSDS must match

•Use •Enter size (As assigned by Code provided 106.31) flow chart

Rust-Oleum Corp. ID0507 11 oz AER See Attached SDS

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Number

(Ass igned by Code 106.31)

CONTRACTOR HAZARDOUS MATERIAL INVENTORY (CHMI) I CODE 106.31 I Document No.

CONTRACTOR - INITIAL REQUEST (Before moving any hazmat onto this Federal facility)

Trade Name6 Process

+Name on product & MSDS Manufacturer7 Code SHIPYARD MSDS Number10

Number8 Container Size & Type9 must match +Name on product & (As assigned by Code

+For kits, list kit name, then list MSDS must match +Use +Enter size

106.31) provided kit components individually flow chart

PSNS & IMF 5090/132 (Rev. 04-13)

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I Page 2 of 2

SHIPYARD Assigned Stock Number (assigned by Code 106.31)

INSTRUCTIONS

Contractor: Fi ll out each section under the heading "CO NTRACTOR" per the…