Attachment_3_-_CDRLs_and_DIDs_-_C.pdf

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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

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

A001 CDRL Production Schedule

DID DI-MGMT-80227

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A001

2_TITLE_OF_DATA_ITEM: PRODUCTION SCHEDULE REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-80227

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.5.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: WEKLY*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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16_REMARKS:

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

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

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

BLOCK 10, 12, and 13: Submit report 24 hours prior to each weekly scheduled production meeting.

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

DATA ITEM DESCRIPTION (DID)

Title: Zinc Anode Location Report

Number: OT-16-20341 dsw Approval Date: 20160812 dsw

AMSC Number: N/A Limitation: N4523A-16-R-0033

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

Office of Primary Responsibility: SH/PUGETNSY

Industrial Management Code 411

Applicable Forms: N/A

Use/Relationship: The report will provide detailed current zinc anode locations of the underwater hull of vessel(s). It will be used by the Government for future drydock blocking plans.

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

This DID is for one time use on solicitation N4523A-16-R-0033 only. dsw

Requirements:

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

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

End of OT-16-20341. dsw

A010 CDRL Zinc Location Report

OT DID 16-20341 Zinc Location Report

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A010

2_TITLE_OF_DATA_ITEM: ZINC ANODE LOCATION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-16-20341

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.2.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: OTIME*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: N/A

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

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

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

Title: Visual Inspection Report

Number: OT-16-20346 dsw Approval Date: 20160811 dsw

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

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

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

2. Content. The Report shall include the following:

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

b. Identified corresponding specific measurements, locations, and/or areas in relationship to structural members or with measurements from suitable reference points.

End of OT-16-20346. dsw

A011 CDRL Visual Inspection Report

OT-DID 16-20346 Visual Inspection Report

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A011

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-16-20346

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.4

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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

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

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

A012 CDRL Visual Inspection Report

OT-DID 16-20346 Visual Inspection Report

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A012

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-16-20346

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.3.5

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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

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

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

A013 CDRL Visual Inspection Report

OT-DID 16-20346 Visual Inspection Report

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A013

2_TITLE_OF_DATA_ITEM: VISUAL TEST INSPECTION (VT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-16-20346

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.2

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

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draft22:

reg22:

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draft23:

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draft24:

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draft29:

reg29:

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draft30:

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addressee38:

draft38:

reg38x:

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total_draft: 0 reg38t: 1 total_repro: 0

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

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

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

Title: Ultrasonic Test (UT) Report

Number: OT-16-20345 dsw Approval Date: 20160811 dsw

Use/Relationship: The report will document the results of Ultrasonic Testing.

It provides the Government with evidence of structural damage and deterioration.

2. Content. The Report shall be in columnar form and include the following:

a. Design thickness.

b. Note if reading is taken over an existing doubler or insert plate.

c. Actual readings taken.

d. Listed and identified corresponding specific measurements, locations, and/or areas in relationship to structural members or with measurements from suitable hull reference points.

e. A sketch of the plating surfaces with required data is an acceptable alternative.

f. Calculate, identify, and highlight measurements indicating a difference

(wastage) greater than 25 percent of the designed plate thickness.

End of OT-16-20245. dsw

A014 CDRL UT Report

OT DID 16-20345 UT Report

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A014

2_TITLE_OF_DATA_ITEM: ULTRASONIC TEST (UT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-16-20345

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.2.5

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

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reg38x:

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total_draft: 0 reg38t: 1 total_repro: 0

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

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

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

Title: Air Test Report

Number: OT-16-20322 dsw Approval Date:20160808 dsw

Use/Relationship: The report is used to document and provide Objective Quality

Evidence (OQE) evidence of the contractor’s Air Test. It is used by the

Government to evaluate the need for vessel repairs that are not covered by the work specifications.

3. Content. The Report shall contain:

a. Clear description of the work requirement.

b. Test result.

c. Recommendation for corrective action.

d. Estimated costs, including labor, subcontractors, material, rework, and any additional costs to ongoing work resulting from the inclusion of the proposed work.

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

End of OT-16-20322. dsw

A015 CDRL Air Test

OT DID 16-20322 Air Test

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: QCIC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A015

2_TITLE_OF_DATA_ITEM: AIR TEST REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-16-20322

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.3

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

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reg37:

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addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 reg38t: 1 total_repro: 0

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

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

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

Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

Title: Air Test Report

Number: OT-16-20322 dsw Approval Date:20160808 dsw

Use/Relationship: The report is used to document and provide Objective Quality

Evidence (OQE) evidence of the contractor’s Air Test. It is used by the

Government to evaluate the need for vessel repairs that are not covered by the work specifications.

3. Content. The Report shall contain:

a. Clear description of the work requirement.

b. Test result.

c. Recommendation for corrective action.

d. Estimated costs, including labor, subcontractors, material, rework, and any additional costs to ongoing work resulting from the inclusion of the proposed work.

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

End of OT-16-20322. dsw

A016 CDRL Air Test

OT DID 16-20322 Air Test

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: QCIC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A016

2_TITLE_OF_DATA_ITEM: AIR TEST REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-16-20322

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.4.7

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

addressee1: PSNS & IMF C/411 draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

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reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 reg38t: 1 total_repro: 0

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

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

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

Representative (COR) specified in the contract.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

Title: Gas Free Program Report

Number: OT-16-20375 dsw Approval Date:20160922 dsw

AMSC Number: N/A Limitation:N4523A-16-R-0033

Office of Primary Responsibility: SH/PNSY

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.

product generated by the specific and discrete task requirements as delineated

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

OT-16-20375 dsw c.Pre-Entry Hazard Assessment d.Hazard Controls

2.6 Entry Permits:

a.Key Elements of Entry Permits b.Permit Scope and Duration

2.7 Entry Procedures:

a.Prior to Entry b.Opening a Confined Space c.Atmospheric Testing d.Isolation and Lockout/Tagout Safeguards e.Ingress/Egress Safeguards f.Warning Signs and Symbols

2.8 Maintenance of Safe Conditions:

a.Conditions b.Tests required

2.9 Emergency Response:

a.Emergency Response Plan b.Retrieval Systems and Methods of Non-Entry Rescue

2.10 Current Roster of the following personnel:

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

b. Certified Industrial Hygienists

c. Qualified Competent Persons

End of OT-16-20375. dsw

A017 CDRL Gas Free Program

OT DID 16-20375 Gas Free Program

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: QCIC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A017

2_TITLE_OF_DATA_ITEM: GAS FREE PROGRAM REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-16-20375

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.21.1

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: A*

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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

addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

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reg38x:

repro38:

total_draft: 1 reg38t: 1 total_repro: 0

16_REMARKS: BlOCK 8: Product shall be approved for technical content. Government requires 5 work days to review and comment. Contractor has 3 working days to incorporate comments and return 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 10 working days prior to the start of contract period of performance.

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

1_DATA_ITEM_NO: A002

2_TITLE_OF_DATA_ITEM: COATING SYSTEM DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: OT-16-20366

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.5.6

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: OTIME

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: N/A

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16_REMARKS:

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

BLOCK 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.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 17, 2016

1_APPROVED_BY:

J_DATE: AUG 17, 2016

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

of_pages: 1

Reset:

2016-08-17T14:30:19-0700

TIEMEYER.JOHN.DAVID.1044537105

2016-08-17T14:31:25-0700

TIEMEYER.JOHN.DAVID.1044537105

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

DATA ITEM DESCRIPTION

Title: CONDITION FOUND REPORT

Number: DI-MGMT-81648 Approval Date: 20040809 AMSC Number: N7531 Limitation: 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

A003 CDRL CFR

DID DI-MGMT-81648

DATA ITEM DESCRIPTION

A_CONTRACT_LINE_ITEM_NO: 0001

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: VESSEL REPAIR SERVICES

E_CONTRACTPR_NO: N4523A-16-R-0033

FCONTRACTOR: TBD

1_DATA_ITEM_NO: A003

2_TITLE_OF_DATA_ITEM: CONDITION FOUND REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-81648

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.11

6_REQUIRING_OFFICE: PSNS & IMF C/411

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(SEE BLK16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16

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16_REMARKS: BLOCK 4: 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.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: AUG 13, 2016

1_APPROVED_BY:

J_DATE: AUG 13, 2016

Page: 1 of_pages: 1

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

DATA ITEM DESCRIPTION

Title: Accidertflncident Report

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

DT3C Applicable: GIDEP Application:

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

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

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

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

1. Format. Contractor format is acceptable

2. Content. Report without delay any serious accident or incident (i.e. explosioq fire, flood pressure rupture, major rndfunction) which will adversely affect capabtity to meet contractual obligations.