N4523A19R1064_Exhibit-A_CDRLs_and_DIDs.pdf
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- N4523A19R1064
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Exhibit A CDRLs and DIDs
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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
0003 A
MGMT
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A001 PRODUCTION SCHEDULE REPORT N/A
DI-MGMT-80227* SOW PARAGRAPH 1.5.1 PSNS & IMF C/411
LT
N/A D(See Block 16)
WEKLY*
N/A
SEE BLOCK 16*
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 first report 5 working days prior to project start date.
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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 10:12:27 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN, cn=STUBBLEFIELD.MATTHEW.COR.1166829778 Date: 2018.10.01 07:55:02 -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
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
0003 A
QCIC
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A002 COATING SYSTEM DATA REPORT N/A
DI-QCIC-82111 SOW PARAGRAPH 1.5.5 PSNS & IMF C/411
LT
N/A D(See Block 16)
OTIME*
N/A
SEE BLOCK 16*
N/A
PSNS & IMF C/411 1
0 1 0
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 and 12: Report shall be submitted 5 business days after contract award.
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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 10:17:58 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778
Date: 2018.10.01 07:50:10 -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 Check the source to verify that this is the current version before use.
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
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
0003 A
SAFT
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A003 SAFETY DATA SHEET (SDS) REPORT N/A
DI-SAFT-82112 SOW PARAGRAPH 1.5.6 PSNS & IMF C/411
LT
N/A D(See Block 16)
OTIME*
N/A
SEE BLOCK 16*
N/A
PSNS & IMF C/411 1
0 1 0
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 and 12: Report shall be submitted 5 business days after contract award.
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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 10:19:08 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778
Date: 2018.10.01 07:44:52 -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
Applicable Forms: N/A
Use/Relationship: The SDS Report will be used by the Government to define product safety and environmental procedures.
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:
https://www.osha.gov/Publications/OSHA3514.html
Requirements:
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
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
0003 A
MGMT
SEGEMENTED BARGE 10504 N4523A19R1064 TBD
A004 CONDITION FOUND REPORT N/A
DI-MGMT-81648* SOW PARAGRAPH 1.11 PSNS & IMF C/411
LT
N/A D(See Block 16)
ASREQ*
N/A
SEE BLOCK 16*
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 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 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.
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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 10:20:25 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778
Date: 2018.10.01 07:43:15 -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
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
0003 A
MGMT
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A005 INCIDENT REPORT N/A
DI-MGMT-82071 SOW PARAGRAPH 1.13.2 PSNS & IMF C/411
LT
N/A D(See Block 16)
ASREQ*
N/A
SEE BLOCK 16*
SEE BLOCK 16*
PSNS & IMF C/411 1
0 1 0
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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 10:22:42 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778
Date: 2018.10.01 07:42:02 -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.
Requirements:
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
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
0003 A
MISC
SEGEMENTED BARGE 10504 N4523A19R1064 TBD
A006 PAINT PRESERVATION APPENDICES N/A
DI-MISC-82120 SOW PARAGRAPH 1.16.1 PSNS & IMF C/411
LT
N/A D(See Block 16)
ASREQ*
N/A
SEE BLOCK16*
SEE BLOCK16*
PSNS & IMF C/411 1
0 1 0
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 1 working day of completion of the following preservation operations: SSPC SP-1, Surface Profiles, Surface Conductivity/ Chloride 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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 10:26:33 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778 Date: 2018.10.01 07:57:06 -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
Applicable Forms: N/A
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.
Requirements:
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
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
0003 A
MGMT
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A007 HAZARDOUS WASTE REPORT N/A
DI-MGMT-82129 SOW PARAGRAPH 1.17 PSNS & IMF C/411
LT
N/A D(See Block 16)
OTIME*
N/A
SEE BLOCK 16*
N/A
PSNS & IMF C/411 1
0 1 0
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 and 12: 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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 10:34:34 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778 Date: 2018.10.01 07:59:19 -07'00'
Title: Hazardous Waste Report
Number: DI-MGMT-82129 Approval Date: 20170608
AMSC Number: N9814 Limitation: N/A
DTIC Applicable: No GIDEP Applicable: No
Preparing Activity: SH Project Number: MGMT-2017-026
Applicable Forms: 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.
Requirements:
1. Format. The Report shall be in contractor’s format.
2. Content. The report shall contain:
2.1. Name, title, description, and quantity of each item.
2.2. Analysis used to identify the hazardous waste.
2.3. Copies of paid invoices and receipts for the disposal of hazardous wastes.
End of DI-MGMT-82129
Source: https://assist.dla.mil -- Downloaded: 2017-06-16T14:12Z
(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
0003 A
MGMT
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A008 GAS FREE PROGRAM REPORT N/A
DI-MGMT-82093 SOW PARAGRAPH 1.22 PSNS & IMF C/411
LT
*A D(See Block 16)
ASREQ*
N/A
SEE BLOCK 16*
SEE BLOCK 16*
PSNS & IMF C/411 1 1
1 1 0
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: 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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 13:24:16 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778 Date: 2018.10.01 08:09:21 -07'00'
Title: GAS FREE PROGRAM REPORT
Number: DI-MGMT-82093 Approval Date: 20161208
AMSC Number: N9754 Limitation: N/A
DTIC Applicable: No GIDEP Applicable: No
Preparing Activity: SH Project Number: MGMT-2017-001
Applicable Forms: N/A
Use/Relationship: The Gas Free Program Report will provide the Government with proof of the
Contractor’s confined space entry/gas free certification processes and qualified personnel, including sub-contractors.
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.
Requirements:
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
2.5 Identification of Hazards and Evaluation of Confined Spaces:
a. Survey
b. Hazard Reevaluation
c. Pre-Entry Hazard Assessment
d. Hazard Controls
Source: https://assist.dla.mil -- Downloaded: 2017-01-05T18:11Z
DI-MGMT-82093
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 DI-MGMT-82093
Source: https://assist.dla.mil -- Downloaded: 2017-01-05T18:11Z
(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
0003 A
MGMT
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A009 TEST AND INSPECTION PLAN (TIP) N/A
DI-MGMT-82062* SOW PARAGRAPH 1.23.1 PSNS & IMF C/411
LT
A* D(See Block 16)
ASREQ*
N/A
SEE BLOCK16*
SEE BLOCK16*
PSNS & IMF C/411 1 1
1 1 0
BLOCK 4: In Title Block Delete "and Inspection" and "(TIP)" In Use/Relationship; after the words "used to identify all" delete "inspections";
after the words "as well" delete "symbol (I) (V) (Q) (G) test/inspections and (G) governments notifications identified in the Work Item, and any additional"; after the words "additional tests" delete "and inspections".
In Format Line, Delete "I" in "TIP"
In Content Line, Delete "I" in "TIP"
Delete "as well as symbols (I)(V)(Q) test/inspections and (G)" Delete "Work Item number" Delete "be inspected" Delete "Inspection symbol (I, V, Q, G) Delete "Standard Item Number" Delete "Standard Item Paragraph" Delete "Name of Government Representative at Inspection" Delete "Inspection Date"
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. Final TIP submission shall be submitted within 24 hours after all testing is complete.
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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 13:26:23 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778 Date: 2018.10.01 08:15:16 -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
GIDEP Applicable: No
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.
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:
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
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
0003 A
MGMT
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A010 VESSEL DOCKING AND UNDOCKING PLAN N/A
DI-MGMT-82094 SOW PARAGRAPH 3.1.2 PSNS & IMF C/411
LT
A* D(See Block 16)
ASREQ*
N/A
SEE BLOCK 16*
SEE BLOCK 16*
PSNS & IMF C/411 1 1
PSNS & IMF C/242 1 1
2 2 0
BLOCK 8: Product shall be approved for technical content. Government requires 5 work days to review and comment.
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 plan a minimum of 5 working days prior to docking and undocking 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.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 13:28:10 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778 Date: 2018.10.01 08:15:59 -07'00'
Title: VESSEL DOCKING AND UNDOCKING PLAN
Number: DI-MGMT-82094 Approval Date: 20161208
AMSC Number: N9755 Limitation: N/A
DTIC Applicable: No GIDEP Applicable: No
Preparing Activity: SH Project Number: MGMT-2017-002
Applicable Forms: N/A
Use/Relationship: The plan will document a detailed plan to safely dock and undock the vessel(s). It is used by the Government to review, comment, and approve docking and undocking plans prior to each docking and undocking evolution.
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 Plan shall be in contractor’s format.
2. Content. The Plan shall include the following Docking Procedures:
a. Operating Practices
b. Safety and Security Plans
c. Special precautions or actions required by the characteristics of the dock, marine railway, or other docking methods
d. Pumping/flooding schedule
e. Specific list, trim, and stability requirements
3. The Plan shall contain:
a. Set and align docking blocks
b. A scaled drawing including block size, block spacing, and location of vessel with respect to the blocks at landing
c. Docking clearances utilizing references for guidance
d. The use of haul, fixed, or fitted blocks
e. The number, distance from centerline, and square footage of the side blocks per side sufficient to resist overturning moments
4. The Plan shall show that at least 90 percent of blocks land on longitudinal strength members or main transverse bulkheads.
End of DI-MGMT-82094
Source: https://assist.dla.mil -- Downloaded: 2017-01-10T14:39Z
(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
0003 A
MGMT
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A011 VESSEL FINAL DOCKING REPORT N/A
DI-MGMT-82130 SOW PARAGRAPH 3.1.12 PSNS & IMF C/411
LT
N/A D(See Block 16)
OTIME*
N/A
SEE BLOCK 16*
N/A
PSNS & IMF C/411 1
PSNS & IMF C/242 1
0 2 0
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 and 12: Submit report within 5 working days of final undocking of the vessel.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Government Docking Observer (GDO) and the Contracting Officer's Representative (COR) specified in the contract.
9-28-18 10-1-18
1 1 CARNEY.SEAN.ROBERT.1165148165 Digitally signed by CARNEY.SEAN.ROBERT.1165148165
Date: 2018.09.28 13:29:46 -07'00' STUBBLEFIELD.MATTHEW.COR.1166829778 Digitally signed by STUBBLEFIELD.MATTHEW.COR.1166829778 Date: 2018.10.01 08:17:00 -07'00'
Title: VESSEL FINAL DOCKING REPORT
Number: DI-MGMT-82130 Approval Date: 20170608
AMSC Number: N9815 Limitation: N/A
DTIC Applicable: No GIDEP Applicable: No
Preparing Activity: SH Project Number: MGMT-2017-027
Applicable Forms: NAVSEA Forms 9997/1 through 9997/5
Use/Relationship: The report will document the results of various vessel drydocking evolutions. It will provide the Government with historical information to be applied to future drydockings.
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 NAVSEA forms 9997/1 through 9997/5 can be obtained as specified in the contract.
Requirements:
1. Format. The Report shall be in contractor’s format.
2. Content. The Vessel Final Docking Report shall contain completed NAVSEA forms
9997/1 through 9997/5 applicable to each vessel.
End of DI-MGMT-82130
Source: https://assist.dla.mil -- Downloaded: 2017-06-16T14:14Z
(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
0003 A
MGMT
SEGMENTED BARGE 10504 N4523A19R1064 TBD
A012 ZINC ANODE LOCATION REPORT N/A
DI-MGMT-82108 SOW PARAGRAPH 3.2.3.2 PSNS & IMF C/411
LT
N/A D(See Block 16)
OTIME*
N/A
SEE BLOCK 16*
N/A
PSNS & IMF C/411 1
0 1 0
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.
BLOCK 10, 12, and 13: Submit report a minimum of 4 working days prior to an…
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