Exh A CDRL A006 CVS TA_CAC REPORT 28 Mar 2011.doc
DOC document 2 MB Posted
- Solicitation number
- N6134011R0039
About this file
Exhibit A CDRLs
View the file
Other files
Show all 24
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CONTRACT DATA REQUIREMENTS LIST (CDRL)
(1 Data Item) Form Approved
OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and 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 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: |
| A LOTS I-V ASK \* MERGEFORMAT |
| TDP ______ |
| TM ______ |
| OTHER: LOGISTICS DATA |
| D. SYSTEM/ITEM |
| E. CONTRACT/PR NO. |
| F. CONTRACTOR |
| FRCMA-PAX CMSS |
| N61340-11-R-0039 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A006 |
| TECHNICAL REPORT – STUDY/SERVICES |
| CVS-TA CAC REPORT |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
TOTAL PRICE
| DI-MISC-80508B |
| SOW PARA 3.1.4, 3.2.5, 4.3.1.2, & 4.7.2 |
FRCMA-PAX CVS-TA
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10. FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| ASREQ |
| SEE BLK 16 |
| a. ADDRESSEE |
| b. COPIES |
| 8. APP CODE |
| F |
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT SUBM. |
| Draft |
| Final |
SEE BLK 16
| Reg |
| Repro |
| 16. REMARKS |
| NAWCTSD PCO |
| LTR |
| ONLY |
1. BLK 4: ONLY DID PARAGRAPH 3 (C).(2) APPLIES. REFER TO ATTACHED ANNEX TO EXHIBIT A006 FOR CVS REGISTRATION FORM AND THE ATTACHED ANNEX SPREADSHEET WORKSHEET PART 5 FOR REPORT FORMAT. SUBMISSIONS SHALL BE FOR ALL ON-SITE EMPLOYEES (PRIME, SUBCONTRACTOR, CONSULTANTS AND TEMPORARY EMPLOYEES) REQUIRING A COMMON ACCESS CARD (CAC). PRIVACY ACT AND PERSONAL INFORMATION PROTECTION REQUIREMENTS AND MARKINGS APPLY FOR THIS REPORT.
2. BLK 4: DELETE PARA 2. SUBMISSION SHALL BE A MICROSOFT @ EXCEL 2003 OR LATER COMPATIBLE SPREADSHEET FORMATTED ( ANNEX) . (NOTE: SOCIAL SECURITY NUMBERS (SSNs) SHALL ONLY APPEAR ON REPORT SUBMITTED TO FRCMA-PAX CVS-TA. COMPLETED CVS REGISTRATION REQUEST FORMS SHALL ONLY BE PROVIDED TO THE FRCMA-PAX CVS-TA.
3. BLK 12: FIRST SUBMISSION SHALL BE DUE PRIOR TO ISSUANCE OF A CAC CARD TO ANY CONTRACTOR EMPLOYEE.
4. BLK 13: UPDATED SUBMISSIONS SHALL BE DUE AS REQUIRED PRIOR TO ISSUANCE OR REMOVAL/SUSPENSION/TERMINATION OF ANY CONTRACTOR PERSONNELS CAC CARD (GAIN OR LOSS OF EMPLOYEE(S).
5. THE GOVERNMENT WILL HAVE 10 WORKING DAYS FOR REVIEW AND ACCEPTANCE/REJECTION OF EACH SUBMISSION.
6. BLK 14: SUBMISSION SHALL BE AN ELECTRONIC ENCRYPTED COPY SENT VIA EMAIL. EMAIL SUBJECT LINE SHALL INCLUDE CONTRACT NUMBER, CDRL DATA ITEM NUMBER. CONTRACT, TITLE, AND DATE OF REPORT. (E.G. N61340-11-C-xxxx - A006- CVS 14 JUL-11). EMAIL ADDRESSES ARE PROVIDED IN THE CONTRACT SCHEDULE. FILES SHALL BE ENCRYPTED USING WINZIP AES 256-BIT ENCRYPTION.
Note *: DO NOT RECEIVE CVS REGISTRATION REQUEST FORMS, ONLY PART 5 SPREADSHEET DATA WITH NO SSN.
Note: ** RECIEVES ANNEX SPREADSHEET PART 5 WITH SSN’S AND COMPLETED ANNEX CVS REGISTRATION REQUEST FORM(S).
7. BLK 9: THE FOLLOWING STATEMENT SHALL BE INCLUDED ON THE DELIVERABLE:
DISTRIBUTION F: DISTRIBUTION AUTHORIZED ONLY AS DIRECTED BY THE CONTROLLING OFFICE (FRCMA-PAX CVS-TA) , (ADMINISTRATIVE OR OPERATIONAL USE ONLY), (10 NOV 2009). OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED TO THE COMMANDING OFFICER, NAVAL AIR WARFARE CENTER, TRAINING SYSTEMS DIVISION, (NAWCTSD PCO, CODE 25332), 12350 RESEARCH PARKWAY, ORLANDO, FL 32826-3275.
8. ACCEPTANCE OF ANY REPORT THAT INCLUDES INFORMATION CONCERNING CHANGES IN CONTRACT REQUIREMENTS/STANDARDS/ SPECIFICATIONS DOES NOT CONSTITUTE GOVERNMENT AGREEMENT TO THOSE CHANGES. ONLY BY DIRECTION OF THE CONTRACTING OFFICER CAN SUCH CHANGES BE MADE.
NAWCTSD PJM *
FRCMA PAX COR *
FRCMA-PAX ACOR *
FRCMA-PAX CVS-TA * *
| 15. TOTAL ▬▬▬▬► |
| 0 |
| 0 |
| 4 |
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| L. DANIELS, NAWCTSD PJM |
| 28 MAR 2011 |
| B. HICKS, NAWC TSD PDX |
| 28 MAR 2011 |
DD FORM 1423-1, FEB 2001
PREVIOUS EDITION MAY BE USED
Page 1 of 3 Pages
ANNEX TO EXHIBIT A - CDRL A006
CVS-TA / CAC Report Report format shall be as follows:
a. CVS Registration Request (below) (also in Exhibit A) shall be completed for each Contractor employee requiring a CAC. .
b. Data from the above forms shall be consolidated in alphabetical order using the Part 5 worksheet of the following spreadsheet.
PART 1 COVER SHEET
PART 5: CVS STATUS REPORT
_1348379530.pdf
CVS REGISTRATION REQUEST
This form is for (select only one) ----------> Initial Issuance: 6 Month Reverification:Reissuance:
Last Name: Middle Name:First Name:
Section I: Applicant Data
Cadency Name:
S S N: Date of Birth:
(mm/dd/yyyy)
E-mail Address:
Personnel Category -------> Navy DoD Contractor Volunteer Other Federal Agency (specify):
Card Expiration Date:
(Include option years. Date not to exceed 3 years or the Contract End Date)
Contract End Date:
Contract Number:
AUTHORITY: 10 U.S.C. 133 and E.O. 9397 Privacy Act Statement PRINCIPAL PURPOSE(S): Collection of social security numbers and other personal identifiers is used to ensure positive identification of individuals in order to successfully register them as CVS users.
ROUTINE USERS: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside the DoD as a routine use as follows: The "Blanket Routine Uses" set forth at the beginning of OSD's compilation of systems of records notices apply to this system. The Federal, State agencies and private entities, as necessary, on matters relating to securing information during the conduct of official business, utilization review, professional quality assurance, program integrity, civil and criminal litigation, and access to Federal government facilities, computer systems networks, and controlled areas.
DISCLOSURE: Voluntary, however, failure to provide this information will result in failure to register an individual as a CVS user.
Section II: Eligibility Requirements (Select all that apply)
The applicant requires access to multiple DoD facilities or access to multiple non-DoD Federal facilities on behalf of the Department on a recurring basis for a period of 6 months or more (this requirement is applicable to DoD contractors only).
The applicant requires both access to a DoD facility and logon access to DoD networks on site or remotely.
The applicant requires remote access to DoD networks that use only the CAC logon for user authentication.
The applicant requires frequent access to a DoD network to perform volunteer duties (volunteers only).
Note: A requirement for access to a CAC enabled DoD website, without also meeting as least one of the above eligibility requirements, does not qualify a DoD contractor to be issued a CAC.
Section III: Background Vetting (Select all that apply)
Contractors & other eligible Federal/State Personnel
The applicant has completed an FBI fingerprint check with favorable results.
A National Agency Check with Inquiries (NACI) has been submitted to the Office of Personnel Management (OPM).
The applicant possesses a valid NACI
The applicant possesses a DoD-determined NACI equivalent investigation: { Select NACI equivalent investigation here } ------>
Volunteer Personnel
The applicant has completed an FBI fingerprint check with favorable results.
A National Agency Check with Inquiries (NACI) has been submitted to the Office of Personnel Management (OPM).
The applicant possesses a valid NAC
The applicant requires logon access to a DoD network to do their job.
Section IV: Sponsor Responsibilities (Select all boxes to acknowledge compliance)
I (the Sponsor) understand I am responsible for each task listed below:
I will notify the assigned CVS Trusted Agent if there is a change in the applicant's status that results in them no longer being eligible to retain the credential I am sponsoring them for.
I will notify the assigned CVS Trusted Agent if the applicant is terminated or moved from under my sponsorship or organization.
If the applicant leaves, is terminated, or transfers to another service organization, I will retrieve their credential and properly dispose of it by returning it to a RAPIDS ID card issuance facility.
Sponsor's Name: Sponsor's Phone #: Sponsor's Email:
(Include option years)
Date: (mm/dd/yyyy)
CVS REGISTRATION REQUEST
This form is for (select only one) ---------->
Section I: Applicant Data
Personnel Category ------->
(Include option years. Date not to exceed 3 years or the Contract End Date)
AUTHORITY: 10 U.S.C. 133 and E.O. 9397 Privacy Act Statement
PRINCIPAL PURPOSE(S): Collection of social security numbers and other personal identifiers is used to ensure positive identification of individuals in order to successfully register them as CVS users.
ROUTINE USERS: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside the DoD as a routine use as follows: The "Blanket Routine Uses" set forth at the beginning of OSD's compilation of systems of records notices apply to this system. The Federal, State agencies and private entities, as necessary, on matters relating to securing information during the conduct of official business, utilization review, professional quality assurance, program integrity, civil and criminal litigation, and access to Federal government facilities, computer systems networks, and controlled areas.
DISCLOSURE: Voluntary, however, failure to provide this information will result in failure to register an individual as a CVS user.
Section II: Eligibility Requirements
(Select all that apply)
Note: A requirement for access to a CAC enabled DoD website, without also meeting as least one of the above eligibility requirements, does not qualify a DoD contractor to be issued a CAC.
Section III: Background Vetting
(Select all that apply)
Contractors & other eligible Federal/State Personnel
Volunteer Personnel
Section IV: Sponsor Responsibilities
(Select all boxes to acknowledge compliance)
(Include option years)
(mm/dd/yyyy)
8.2.1.3144.1.471865.466429
CheckBox1: 0
CheckBox1: 0
CheckBox1: 0
CheckBox1: 0
CheckBox1: 0
TextField1:
TextField2:
DateTimeField1:
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
CheckBox2: 0
DropDownList1:
ResetButton1:
PrintButton1:
_1359365958.xls Pt 1 CDRL Cover
PART 1: COVER SHEET Ver 15 Feb 11
Title: FRCMA-PAX Monthly Measurement Report Contractor Maintenance Support Hours Measurement and Manning Report
Contract #: N61340-11-C-xxxx
Report Period: 1-31 May 2010
CDRL #: A010 NOTE: GOVT ONLY/FOUO RELATIVE TO THE FRCMA-PAX CONTRACT.
Contractor: ABC Inc [ ] CONTAINS PRIVACY ACT STATEMENT DATA - SAFEGAURD RQRD
Contractor Signature: Date: Email: Phone:
John Contractor, Site Mgr ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks:
COR Signature: Date: Email: Phone:
Bill COR, FRCMA-Pax ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks (note any attachments):
Contractor Summary of Contractor Milestones/ Accomplishments/ Comments:
CHECK APPLICABLE CONTENTS OF THIS REPORT:
[ X ] PART 1 COVER SHEET *
[ ] PART 2 MSF MEASUREMENT *
[ ] PART 3 QA MEASUREMENT *
[ ] PART 4 MANNING REPORT *
[ X ] PART 5 CVS STATUS * AND **
[ ] PART 6 PREMIUM TIME REPORT
[ ] Other_____________
NOTE * : NOTE: PRIVACY ACT INFORMATION statement SAFEGAURDS . If transmitted electronically. It must be encrypted using WINZIP AES 256-BIT encryption
NOTE ** : ALL REPORT DATA WILL AND SHALL BE STORED IN A SECURE MANNER.
ALL REPORT DATA IS FOUO AND NOT FOR DISTRIBUTION OUTSIDE CDRL DISTRIBUTION LIST. ALL OUTSIDE REQUESTS MUST GO
THROUGH NAWCTSD ORL FREEDOM OF INFORMATION ACT PROCESS.
xxx@ctxtcom
Pt 2 MSF Measurement
PART 2: MSH REPORT
Title: FRCMA-PAX Monthly Measurement Report Ver 15 Feb 11
Contract #/Name: N61340-11-C-xxxx / ABC, Inc Contractor Maintenance Support Factor Measurement Report
Report Period: 1-31 May 2010
CDRL #: A010 NOTE: GOVT ONLY/FOUO RELATIVE TO THE FRCMA-PAX CONTRACT.
Contractor Signature: Date: Email: Phone:
John Contractor, Site Mgr ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks:
COR Signature: Date: Email: Phone:
Bill COR, FRCMA-Pax ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks (note any attachments):
LOT MSF ARCHIVE:
Summary: Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
MSH =
Cumulative MSF =
Workdays in Report Perod (days): 21
Monthly MAINTENANCE SUPPORT FACTOR (MSF): Std Sched. MSH for Report Period (Hrs)= 168
NAME Work Ctr: Position/Qual/ Certif Title On-site Maint Hrs: Training Hrs: Vacation / Sick Lv Hrs: Other Hrs: MSHF (Failure/ No show) Hrs: Premium Time Hrs Rprt Period Total MSH Hrs: MSF (%) Remarks: (Notecompleted vacation/sick times)
SAMPLE, Fed 0F8 AMI 100.0 34.0 24.0 8.0 2.0 1.0 169 98.8% 8 hrs off CO authorized closure
1 0.0 N/A
2 0.0 N/A
3 0.0 N/A
4 S 0.0 N/A
5 0.0 N/A
6 0.0 N/A
7 0.0 N/A
8 0.0 N/A
9 0.0 N/A
10 0.0 N/A
11 0.0 N/A
12 0.0 N/A
13 0.0 N/A
14 0.0 N/A
15 0.0 N/A
16 0.0 N/A
17 0.0 N/A
18 0.0 N/A
19 0.0 N/A
20 0.0 N/A
21 0.0 N/A
22 0.0 N/A
23 0.0 N/A
24 0.0 N/A
25 0.0 N/A
26 0.0 N/A
27 0.0 N/A
28 0.0 N/A
29 0.0 N/A
30 0.0 N/A
31 0.0 N/A
32 0.0 N/A
33 0.0 N/A
34 0.0 N/A
35 0.0 N/A
36 0.0 N/A
37 0.0 N/A
38 0.0 N/A
39 0.0 N/A
40 0.0 N/A
41 0.0 N/A
42 0.0 N/A
43 0.0 N/A
44 0.0 N/A
45 0.0 N/A
46 0.0 N/A
47 0.0 N/A
48 0.0 N/A
49 0.0 N/A
50 0.0 N/A
51 0.0 N/A
52 0.0 N/A
53 0.0 N/A
54 0.0 N/A
55 0.0 N/A
56 0.0 N/A
57 0.0 N/A
58 0.0 N/A
59 0.0 N/A
60 0.0 N/A
61 0.0 N/A
62 0.0 N/A
63 0.0 N/A
64 0.0 N/A
65 0.0 N/A
66 0.0 N/A
67 0.0 N/A
68 0.0 N/A
69 0.0 N/A
70 0.0 N/A
71 0.0 N/A
72 0.0 N/A
73 0.0 N/A
74 0.0 N/A
75 0.0 N/A
76 0.0 N/A
77 0.0 N/A
78 0.0 N/A
0.0 N/A
SUMMARY: Contractor Maintenance Support Factor Measurement Report
TOTALS = 0.0 0.0 0.0 0.0 0.0 0.0 0.0 N/A
On-site Maint Hrs: Training Hrs: Vacation / Sick Lv Hrs: Other Hrs: MSHF (Failure/ No show) Hrs: Premium Time Hrs Total SMSH Hrs: MSHF (Failure) Hrs:
REPORT PERIOD MAINTENANCE SUPPORT FACTOR (MSF) = N/A
EXPLAIN IN REMARKS COLUMN
SAMPLE
SAMPLE
Pt 3 QA Measurement
PART 3: FQAF and NFQAF REPORT Ver 15 Feb 11
Title: FRCMA-PAX Monthly Measurement Report
Contract #/ Name: N61340-11-C-xxxx / ABC, Inc Quality Assurance Factor Report
Report Period: 1-31 May 2010 NOTE: GOVT ONLY/FOUO RELATIVE TO THE FRCMA-PAX CONTRACT.
CDRL #: A010
Contractor Signature: Date: Email: Phone:
John Contractor, Site Mgr ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks:
COR Signature: Date: Email: Phone:
Bill COR, FRCMA-Pax COR ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks (Note any attachments):
Monthly SAFETY OF FLIGHT QAF LOT FQAF ARCHIVE:
Work Center: FCN FCU FCD Report Period Work Ctr FQAF Cumulative FQAF to Date Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Monthly NON-SAFETY OF FLIGHT QAF: LOT NFQAF ARCHIVE:
Work Center: NFCN NFCU NFCD Report Period Work Ctr NFQAF Cumulative NFQAF to Date Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
ENTER FOR EACH WORK CENTER WHERE APPLICABLE
ENTER FOR EACH WORK CENTER WHERE APPLICABLE
Pt 4 Manning Report
PART 4: MANNING STATUS REPORT Ver 15 Feb 11
Title: FRCMA-PAX Monthly Measurement Report FRCMA-PAX MANNING STATUS REPORT
Contract #/ Name: N61340-11-C-xxxx/ ABC, Inc
Report Period: 1-31 May 2010 NOTE: PRIVACY ACT INFORMATION / PERSONAL IDENTITY INFO SAFEGAURDS MARKINGS REQRD.
CDRL #: A010 If transmitted electronically. It must be encrypted using WINZIP AES 256-BIT encryption
Contractor Signature: Date: Email: Phone:
John Contractor, Site Mgr ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks:
COR Signature: Date: Email: Phone:
Bill COR, FRCMA-Pax ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks (note any attachments):
Submit in order of Work Centers:
FY-__ CLIN/ SLIN: NAME (* New Hire/ ** Terminated) Work Ctr: Hire Aniv Date: On-Site Date: Qual/ Certif Title Planned Vacation/ Leave License and Certifictions w/Exp Dates CAC Card Exp Date Security Clearance (Y or N) /Exp date) Employment Termination Date: (ddmmmyy) Remarks: (Note vacation times; employment terminations dates; destruction/turn-in of CAC card)
1 SAMPLE, Fred X5O SM
2 X5O SMC
3 X5O SQI
4 X5O QI-AP
5 X5O QI-ALSS
6 X5O QI-AV
7 X5M ST-IMRL
8 X5M ST-IMRL
9 X5M ST-IMRL
10 X5M ST-IMRL
11 X5M ST-IMRL EXP
12 X5H/ X5S HMWS
13 X5H ST-H
14 X5H ST-H
15 X5S ASW
16 X5L /X5E EWS-56
17 X5L AM-T56
18 X5L AM-T56
19 X5L AM-T56
20 X5L AM-T56
21 X5L AM-T56
22 X5L AM-T56
23 X5L AM-T56
24 X5L AM-T56
25 X5L AM-T56
26 X5L AM-T56
27 X5L AM-T56
28 X5L PCC-T56
29 X5E ETTC
30 X5B/ X5A/ X5C AVWS
31 X5B ETBS
32 X5B ETBS
33 X5B ETBS
34 X5A ETATE
35 X5A ETATE
36 X5C ETCAL
37 X5C ETCAL
38 X58/ X5D/ X5F/ X5P ALSSWS
39 X58 ST-ALSS
40 X58 PCC-ALSS
41 X58 PCC-ALSS
42 X5D AM-ALSS
43 X5D AM-ALSS
44 X5D AM-ALSS
45 X5F AM-ALSS
46 X5F AM-ALSS
47 X5F AM-ALSS
48 X5F AM-ALSS
49 X5F AM-ALSS
50 X5F AM-ALSS
51 X5P AM-ALSS
52 X5P AM-ALSS
53 X5P AM-ALSS
54 X5T/ X55 TPWS
55 X5T AW
56 X5T AW
57 X5T AW
58 X55 PSWS2
59 X55 AP
60 X55 AP
61 X55 AP
62 X55 AP 2nd
63 X55 AP 2nd
64 X59 SEWS
65 X59 MVMSE
66 X59 MVMSE
67 X59 MVMSE
68 X59 MVMSE
69 X59 MVMSE
70 X59 MVMSE
71 X59 MVMSE
72 X59 MVMSE
73 X59 AWSE
74 X59 AWSE
75 X59 PCC-SE
Pt 5 CVS Status
PART 5: CVS SUMMARY REPORT Ver 08 Oct 10
Title: FRCMA-PAX Monthly Measurement Report NOTE: PRIVACY ACT INFORMATION / PERSONAL IDENTITY INFO SAFEGAURDS MARKINS REQRD.
Contract #: N61340-11-C-xxxx If transmitted electronically. It must be encrypted using WINZIP AES 256-BIT encryption
Report Period: 1-31 May 2010 FRCMA-PAX CVS SUMMARY REPORT
CDRL #: A010
Contractor: ABC, Inc NOTE: GOVT ONLY/FOUO RELATIVE TO THE FRCMA-PAX CONTRACT.
Contractor Signature: Date: Email: Phone:
John Contractor, Site Mgr ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks:
COR Signature: Date: Email: Phone:
Bill COR, FRCMA-Pax ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks (note any attachments):
CVS REGISTATION REQUEST FORM DATA:
SECTION I (Applicant Data) Section II: Elegibility Rqrmts Section III: Backgrd Vetting Section IV: Sponsor Responsibility
Active Issued CAC? (A,D,I,T) Purpose Last Name (In Alphabetical Order)) First Name MI Cadency Name SSN xxx-xx-xxxx Birth Date ddmmmyy EMAIL Address Personnel Category Card Exp Date ddmmmyy Contract End Date ddmmmyy State Applicable Rqrmt: Favorable FBI Fingerprint Chk? NACI Submitted to OPM? Approved / In DEERS? Termination Date ddmmmyy CAC Expire Date: ddmmmyyy Sponsor Name / Email/Phone Type and Date of NACI (BI) CAC Confiscated and Destroyed ddmmmyyy Destruction Confirmation POC
A = ACTIVE CAC
D = DESTROYED CAC
I = INPROCESS OF ACQUIRING CAC
T = TRANSFERRED CAC TO OTHER CVS TA
INITIAL, REISSUE, OR 6 MO REVERIFICATION
NAVY DOD CONTRACTOR, VOLUNTEER, Other FED AGENCY (specify)
USE DARK GRAY BACKGROUND FOR INACTIVE; LIST ACTIVE AND INACTIVE TOGETHER SEPARATELY
A=ACTIVE CAC; D=DESTROYED CAC
I= INPROCESS OF ACQUIRING CAC
T=TRANSFERRED CAC
TO OTHER CVS TA
ALPHABETICAL ORDER
PT 6 Premium Time Summary
Ver 15 Feb 11
PART 6: CONTRACTOR PREMIUM TIME SUMMARY
Title: FRCMA-PAX Monthly Measurement Report CONTRACTOR PREMIUM TIME SUMMARY
Contract #/Name: N61340-11-C-xxxx / ABC, Inc
Report Period: 1-31 May 2010
CDRL #: A010
Contractor Signature: Date: Email: Phone:
John Contractor, Site Mgr ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks:
COR Signature: Date: Email: Phone:
Bill COR, FRCMA-Pax ddmmmyy xxx@ctxtcom (###)###-#####
Signature: Remarks (note any attachments):
Work Center: Qualification Premium Time this Report Period (Hrs)) Cummulative Premium Time this LOT Period (hrs)
1 X5O SM
2 X5O SMC
3 X5O SQI
4 X5O QI-AP
5 X5O QI-ALSS
6 X5O QI-AV
7 X5M ST-IMRL
8 X5M ST-IMRL
9 X5M ST-IMRL
10 X5M ST-IMRL
11 X5M ST-IMRL EXP
12 X5H/ X5S HMWS
13 X5H ST-H
14 X5H ST-H
15 X5S ASW
16 X5L /X5E EWS-56
17 X5L AM-T56
18 X5L AM-T56
19 X5L AM-T56
20 X5L AM-T56
21 X5L AM-T56
22 X5L AM-T56
23 X5L AM-T56
24 X5L AM-T56
25 X5L AM-T56
26 X5L AM-T56
27 X5L AM-T56
28 X5L PCC-T56
29 X5E ETTC
30 X5B/ X5A/ X5C AVWS
31 X5B ETBS
32 X5B ETBS
33 X5B ETBS
34 X5A ETATE
35 X5A ETATE
36 X5C ETCAL
37 X5C ETCAL
38 X58/ X5D/ X5F/ X5P ALSSWS
39 X58 ST-ALSS
40 X58 PCC-ALSS
41 X58 PCC-ALSS
42 X5D AM-ALSS
43 X5D AM-ALSS
44 X5D AM-ALSS
45 X5F AM-ALSS
46 X5F AM-ALSS
47 X5F AM-ALSS
48 X5F AM-ALSS
49 X5F AM-ALSS
50 X5F AM-ALSS
51 X5P AM-ALSS
52 X5P AM-ALSS
53 X5P AM-ALSS
54 X5T/ X55 TPWS
55 X5T AW
56 X5T AW
57 X5T AW
58 X55 PSWS2
59 X55 AP
60 X55 AP
61 X55 AP
62 X55 AP 2nd
63 X55 AP 2nd
64 X59 SEWS
65 X59 MVMSE
66 X59 MVMSE
67 X59 MVMSE
68 X59 MVMSE
69 X59 MVMSE
70 X59 MVMSE
71 X59 MVMSE
72 X59 MVMSE
73 X59 AWSE
74 X59 AWSE
75 X59 PCC-SE
Sheet1
File details come from the government source that posted it. Updated .