C04.0 N4523A23R1056 YC-1569 & YC-1570 Exhibit A CDRLs and DIDs.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

1_DATA_ITEM_NO: A006

2_TITLE_OF_DATA_ITEM: PAINT PRESERVATION APPENDICES REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-82120

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.16.1

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/101.11, Bremerton, WA 98314.

BLOCK 10, 12 and 13: Submit documents to include Calibrated Electronic Data Logger records 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.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 17 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: YC - 1569

E_CONTRACTPR_NO: N4523AR23R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T06:28:38-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T11:18:01-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

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: A027

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/101.11

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

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/101.11, 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: 18 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: YC - 1570

E_CONTRACTPR_NO: N4523A23R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-18T10:10:29-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T12:54:33-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

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: A045

2_TITLE_OF_DATA_ITEM: STRUCTURAL INSPECTION REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82065*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.5.5

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 4:

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

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

BLOCK 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/101.11, Bremerton, WA 98314.

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

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 18 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: YC - 1570

E_CONTRACTPR_NO: N4523A23R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T10:01:31-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T13:29:12-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

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: A007

2_TITLE_OF_DATA_ITEM: CERTIFICATION/DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-80678*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.16.2.1

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

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:

Preparation Instructions Block: Delete paragraphs 10.1, 10.2.2, 10.2.3, 10.2.4.

Paragraph 10.2.1, Delete after the word Objective evidence, "may", Delete after the words "such items as", spectrographs, radiographs, material sampling, analysis"

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/101.11, Bremerton, WA 98314.

BLOCK 10, 12, and 13: Submit report within 2 working days of completion of each inspection and 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: 17 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: YC - 1569

E_CONTRACTPR_NO: N4523A23R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T06:44:18-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T11:20:38-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

DATA ITEM DESCRIPTION

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

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

DATA ITEM DESCRIPTION

Title: Ultrasonic Test (UT) Report

Number: DI-NDTI-82095 Approval Date: 20161208

AMSC Number: N9756 Limitation: N/A

DTIC Applicable: No GIDEP Applicable: No

Preparing Activity: SH Project Number: NDTI-2017-002

Applicable Forms: N/A

Use/Relationship: The Ultrasonic Test (UT) Report will document the results of Ultrasonic

Testing. It will provide the Government with evidence of structural damage and deterioration.

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 UT Report shall be in contractor’s format.

2. Content. The UT report shall include the following:

a. Contractor’s name and address.

b. Contract number.

c. Work item number.

d. Paragraph number.

e. Date of report.

f. Test results.

End of DI-NDTI-82095

Source: https://assist.dla.mil -- Downloaded: 2017-01-05T18:03Z

Source: https://assist.dla.mil -- Downloaded: 2016-02-24T13:38Z

Title: INCIDENT REPORT

Number: DI-MGMT-82071

AMSC Number: N9720

DTIC Applicable: No

Preparing Activity: SH

Approval Date: 20161003

Limitation: N/A

GIDEP Applicable: No

Project Number: MGMT-2016-058

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

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

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

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

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

DI-MGMT-82071

Figure 1

INCIDENT REPORT

Report #

INITIAL REPORT REQUESTED UPDATE FINAL REPORT

TYPE OF INCIDENT:

NAME(S) OF INJURED (if applicable):

INCIDENT DATE: TIME: COMPANY:

SUPERVISOR:

LOCATION OF INCIDENT: TYPE OF INJURY OR FIRE:

CAUSE OF INCIDENT: EQUIPMENT INVOLVED:

WORK ITEM NUMBER: CONTRACT NUMBER:

WITNESS AND/OR INDIVIDUALS INVOLVED

NAME(S) DEPT. COMPANY

DESCRIPTION OF INCIDENT

INVESTIGATED BY (NAME): TITLE:

SIGNATURE OF INVESTIGATOR: DATE:

DISPOSITION OF INJURED (if applicable)

IMMEDIATE CORRECTIVE ACTION

FIGURE 1 (continued)

LONG TERM CORRECTIVE ACTION

INVESTIGATED BY (NAME): TITLE:

SIGNATURE OF INVESTIGATOR: DATE:

INCIDENT REPORT

Report #

ROOT CAUSE ANALYSIS

FIGURE 1 (continued) Incident Report Instructions

REPORT NUMBER- Unique tracking number created by contractor

TYPE OF INCIDENT- Injury, fire or near miss

NAME(S) OF INJURED- Self Explanatory

INCIDENT DATE: - Self Explanatory

TIME: - Self Explanatory

COMPANY: - Prime and subcontractors involved

SUPERVISOR – Supervisor of employee(s) involved

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

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

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

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

ITEM NUMBER – Work Item being accomplished when incident occurred

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

(AIT) Sponsor.

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

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

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

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

INVESTIGATED BY – Self Explanatory.

TITLE – Self Explanatory.

SIGNATURE OF INVESTIGATOR – Self Explanatory.

DATE – Self Explanatory.

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

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

Note: Attach additional information as necessary.

End of DI-MGMT-82071

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: A046

2_TITLE_OF_DATA_ITEM: ULTRASONIC TEST (UT) REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-NDTI-82095

5_CONTRACT_REFERENCE: SOW PARAGRAPH 3.5.6.1

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

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/101.11, 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: 18 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: NDTI

DSYSTEMITEM: YC - 1570

E_CONTRACTPR_NO: N4523A23R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T10:02:32-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T13:30:48-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

Title: Hazardous Waste Report

Number: DI-MGMT-82129 Approval Date: 20170608

AMSC Number: N9814 Limitation: N/A

Preparing Activity: SH Project Number: MGMT-2017-026

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.

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

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: A028

2_TITLE_OF_DATA_ITEM: INCIDENT REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82071

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.13.2

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

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/101.11, Bremerton, WA 98314.

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

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 18 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: YC - 1570

E_CONTRACTPR_NO: N4523A23R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T09:34:37-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T12:58:17-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

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: A010

2_TITLE_OF_DATA_ITEM: TEST AND INSPECTION PLAN (TIP)

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82062*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.23.1

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: A*

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

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16_REMARKS: BLOCK 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/101.11, 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.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 17 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: YC - 1569

E_CONTRACTPR_NO: N4523A23R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T08:33:33-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T11:27:38-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

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: A008

2_TITLE_OF_DATA_ITEM: HAZARDOUS WASTE REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82129

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.17

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

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/101.11, 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.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 17 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: YC - 1569

E_CONTRACTPR_NO: N4523A23R1056

FCONTRACTOR: TBD

of_pages: 1

Reset:

2022-11-15T06:36:20-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T11:23:48-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

Title: PAINT PRESERVATION APPENDICES REPORT

Number: DI-MISC-82120 Approval Date: 20170410

AMSC Number: N9794 Limitation: N/A

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

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

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

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

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

Sample Figures 1 through 9.

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

DI-MISC-82120

SAMPLE FIGURE-1

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End of DI-MISC-82120

SAMPLE FIGURE 9

Title: GAS FREE PROGRAM REPORT

Number: DI-MGMT-82093 Approval Date: 20161208

AMSC Number: N9754 Limitation: N/A

Preparing Activity: SH Project Number: MGMT-2017-001

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.

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

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: A029

2_TITLE_OF_DATA_ITEM: PAINT PRESERVATION APPENDICES REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-82120

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.16.1

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK16*

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16_REMARKS: BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/101.11, Bremerton, WA 98314.

BLOCK 10, 12 and 13: Submit documents to include Calibrated Electronic Data Logger records 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.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 18 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

TM:

OTHER: MISC

DSYSTEMITEM: YC - 1570

E_CONTRACTPR_NO: N4523AR23R1056

FCONTRACTOR: TBD

of_pages: 1

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2022-11-15T09:43:07-0800

WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T12:59:43-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

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: A009

2_TITLE_OF_DATA_ITEM: GAS FREE PROGRAM REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MGMT-82093

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.22

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: *A

DIST_STATEMENT: D(See Block 16)

10_FREQUENCY: ASREQ*

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: SEE BLOCK 16*

13_DATE_OF_SUBSEQUENT_SUB: SEE BLOCK 16*

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16_REMARKS: BLOCK 8: Product 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/101.11, Bremerton, WA 98314.

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

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

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

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE: 17 NOV 2022

1_APPROVED_BY:

J_DATE: 12/22/22

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO: 0005

B_EXHIBIT: A

TDP:

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OTHER: MGMT

DSYSTEMITEM: YC - 1569

E_CONTRACTPR_NO: N4523A23R1056

FCONTRACTOR: TBD

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WILSON.TODD.CHRISTOPHER.SR.1408956826

2022-12-22T11:25:45-0800

STUBBLEFIELD.MATTHEW.COR.1166829778

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: A030

2_TITLE_OF_DATA_ITEM: CERTIFICATION/DATA REPORT

3_SUBTITLE: N/A

4_AUTHORITY_Data_Acquisit: DI-MISC-80678*

5_CONTRACT_REFERENCE: SOW PARAGRAPH 1.16.2.1

6_REQUIRING_OFFICE: PSNS & IMF C/101.11

7_DID_250_REQ: LT

8_APP_CODE: N/A

DIST_STATEMENT: D(See Block 16)

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…