09 Exhibit A - Little Creek 100MT MBH Rev 1.pdf

1.0

1.1

Code Frequency

DAILY

WEEKLY

BI-WE

MTHLY

BI-MO

QRTLY

2/MTH

XTIME

2TIME/R

ANNLY

SEMIA

OTIME

ONE/R

ASREQ

CP/RQ

2TIME

*DFDEL

ONE/P

1.2

1.3

1.4 The NAVCRANECEN Project Manager shall be notified by email when a submission is submitted via DoD Safe for review. The Government review period will begin on the latter date of: email notification or date of receipt from DoD Safe. If the email or DoD Safe submission are received after 1400 EST, they will be considered received the next business day. Submittal review periods are business days unless otherwise specified. Business days (regular working hours) are defined in the Appendix H under section 3.1.

Contracts Data Requirements List (CDRL)

EXHIBIT A

Daily

Data to be delivered under this contract is identified in Exhibit A (DD Forms 1423) and further described in Exhibit B (DD Forms 1664) and the technical specification. All data submitted shall utilize British System units of measure and the English language exclusively.

Quantities/distribution points listed in block 14 of DD Forms 1423 shall apply to all submissions. Latest edition of referenced document noted in block 4 is required. Codes used in blocks 8 and 10 are described as follows:

Little Creek 100MT MBH Virginia Beach, VA

References include subordinate paragraphs.

Distribution addresses for the submission of data are provided on page 2.

Deferred delivery (rarely used)

Change pages as required when procuring

One time preliminary & revisions draft

Quarterly Semimonthly

Weekly Each two weeks

Each two months

Annually

DD Forms 1423

Two separate submittals

Monthly

2 separate submittals

One time One time with revisions as required As required

Each six months

X separate submittals

The data items included in this Section are required by the applicable clauses of Federal Acquisition Regulations (FAR) 52.2 and Defense Federal Acquisition Regulation (DFAR) 252.227

Exhibit A Page 1 of 25 Rev. 1

NAVCRANECEN

JEBLC

DCMA

NAVCRANECEN:

email:

phone:

JEBLC

email:

phone:

Attn: Brittany Copeland brittany.a.copeland2.civ@us.navy.mil 757-967-3842

Attn: Ricky Hartman

Portsmouth VA 23709-1044

Project Manager - Code 01 Norfolk Naval Shipyard, Bldg 491

Navy Crane Center, Naval Facilities Engineering Systems Command

Little Creek 100MT MBH Virginia Beach, VA

Distribution addresses for the submission of data:

Abbreviations used:

Joint Expeditionary Base Little Creek

Defense Contract Management Agency

Director, Navy Crane Center

Virginia Beach, VA 23459 ricky.hartman@socom.mil 757-763-3704

Joint Expeditionary Base Little Creek

Naval Facilities Engineering Systems Command

Supply Officer, NSWG-8, 1600 Seabee Dr, BLDG CB-318

Exhibit A Page 2 of 25 Rev. 1

Data Item Page

A001 4 A002 5 A003 6 A004 7 A005 8 A009 9 A010 10 A011 11 A012 12 A013 13 A016 14 A017 15 A018 16 A020 17 A022 18 A025 19 A026 20 A027 21 A028 22 A029 23 A030 24 A032 25

CERTIFICATION, SHACKLES

MBH SHIPPING PLAN

CERTIFICATION, EPA EMISSIONS

CERTIFICATION, PUBLIC DOMAIN SOFTWARE

COMPUTER DOCUMENTATION

CONTROL SYSTEM INVENTORY

EVALUATION STATUS

TRAINING COURSE OUTLINE

FREQUENCY ALLOCATION APPLICATION

PROPERTY TRANSFER VERIFICATION

CONFERENCE MINUTES

CONTRACTOR CRANE ENTRY PACKAGE

CERTIFICATION, SLINGS

CERTIFICATION, CONTRACTOR'S SELF TEST

TEST PROCEDURES & REPORTS

CRANE REMOVAL / INSTALLATION PLAN

ACCIDENT PREVENTION PLAN

CONTRACT DATA REQUIREMENTS LIST

TABLE OF CONTENTS

Little Creek 100MT MBH

Virginia Beach, VA

STATUS REPORT

DESIGN PACKAGE

REQUEST FOR INFORMATION

OPERATION AND MAINTENANCE MANUAL

CERTIFICATION, WIRE ROPE

Exhibit A Page 3 of 25 Rev. 1

TDP X TM

7. DD 250 REQ

LT

8. APPL CODE

A 0 1 0 1

0 2

H. DATE

9/23/2025

Physical Copy

Electronica. ADDRESSEE

NAVCRANECEN

JEBLC

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

F. CONTRACTOR

A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

A. CONTRACT LINE ITEM NO. B. EXHIBIT

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Status Report

9. DISTRIBUTION

STATEMENT

4. AUTHORITY

DI-MGMT-80368A

5. CONTRACT REFERENCE

Para. 4.11

12. DATE OF FIRST SUBMISSION

See Block 16

6. REQUIRING OFFICE

NAVCRANECEN

3. SUBTITLE

14. DISTRIBUTION

J. DATE

9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

10. FREQUENCY

MTHLY

16. REMARKS

11. AS OF DATE 13. DATE OF SUBSEQUENT SUBM.

See Block 16

INITIAL SCHEDULE:

Provide initial schedule within 10 business days of contract award. Provide a submission in accordance with blocks 4 and 5. The contractor will be notified within 10 business days if revision and resubmission is required. Resubmittals, if required, shall be provided to NAVCRANECEN within 5 business days after return of Government review comments.

MONTHLY STATUS REPORT:

Provide monthly status report and schedule by the first day of the month. Provide updated schedule when events change the schedule. Provide a submission in accordance with blocks 4 and 5. The contractor will be notified within 10 business days if revision and resubmission is required. Resubmittals, if required, shall be provided to NAVCRANECEN within 5 business days after return of Government review comments.

In addition to the narrative report described in block 4, the crane contractor shall prepare and submit a detailed graphic and tabular schedule showing design, manufacturing, delivery and acceptance activities for the crane. Initial schedule submission shall be the baseline from which monthly progress shall be measured.

Each monthly report after the initial submission should address issues that will potentially delay, or have delayed, the schedule previously provided. This report shall also identify all NCC-to-Contractor issues that have not been resolved.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

ONSITE WORK SCHEDULE:

Provide onsite work schedule a minimum of 30 calendar days prior to the contractor's desired mobilization date. Provide submission in accordance with blocks 4 and 5.

ONSITE WORK DAILY STATUS REPORT:

Provide daily status report by close of business, starting at mobilization date through acceptance date while onsite work is being performed. Provide submission in accordance with block 4.

In addition to the narrative report described in block 4, the crane contractor shall provide a narrative of work events during the reported business day, significant observations and concerns identified, and a schedule of events for the remainder of business days on site.

15. TOTAL

Exhibit A Page 4 of 25 Rev. 1

LT

8. APPL CODE

A

0 1 0 1

NAVCRANECEN 0 1

1 1

NAVCRANECEN 0 0

2 0

NAVCRANECEN 1 0

2 0

6 4

H. DATE

9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete

15. TOTAL

16. REMARKS

JEBLC

DESIGN PACKAGE

POST-SHOP TEST AS-BUILTS

FINAL PAPER AS-BUILTS

JEBLC

J. DATE

9/23/2025

Electronica. ADDRESSEE

14. DISTRIBUTION

F. CONTRACTOR

3. SUBTITLE

6. REQUIRING OFFICE

NAVCRANECEN

Physical Copy

A. CONTRACT LINE ITEM NO. B. EXHIBIT

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

5. CONTRACT REFERENCE

See Block 16

See Block 16

0001 A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

10. FREQUENCY

ASREQ

9. DISTRIBUTION

STATEMENT

DI-SESS-81000F, DI-SDMP-81261,

DI-AVCS-80700A

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

Design Package

4. AUTHORITY

Para 4.1, Para 4.2, Para 4.3, Para 4.10, Para 4.15.3

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT SUBM.

JEBLC

NAVCRANECEN

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

JEBLC

DESIGN PACKAGE:

Each design package submitted (initial and subsequent) shall be considered a final submittal and shall be complete containing all the most updated drawing and submittal revisions in accordance with blocks 4 and 5. NAVCRANECEN reserves the right to reject and require resubmittal of any incomplete design package. NAVCRANECEN will determine acceptability within 15 business days after initial design package submittal. All subsequent Government review periods shall be complete within 10 business days of receipt of resubmission. The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval of Design Package is required 20 business days prior to shop test.

After NAVCRANECEN design approval and prior to shop test, the Contractor shall submit a complete set of approved design drawings.

POST-SHOP TEST AS-BUILT DRAWINGS:

All as-built drawing deficiencies identified prior to crane shipment (including during shop test) shall be corrected prior to crane shipment unless NAVCRANECEN approves deferring this requirement. The corrected (or most recent if corrections are deferred) as-built drawing package shall be furnished via physical paper and electronic copies in accordance with blocks 4 and 5 at the time of crane shipment.

NAVCRANECEN will determine acceptability within 10 business days after crane acceptance. All subsequent Government review periods shall be complete within 10 business days of receipt of resubmission. The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

FINAL AS-BUILT DRAWINGS:

Upon Government approval of the Post-Shop Test As-Built Drawings, these drawings become the Final As-Built Drawings. Provide the approved Final As-Built Drawings on CD-ROM and paper copy in accordance with blocks 4 and 5 no later than 20 business days after crane acceptance. Submit printed drawings and CD-ROM(s) via overnight private courier. NAVCRANECEN will determine acceptability within 10 business days after submittal. All subsequent Government review periods shall be complete within 10 business days of receipt of resubmission.

FINAL CD-ROM AS-BUILTS

Exhibit A Page 5 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 0 0

0 1

H. DATE

9/23/2025

15. TOTAL

REQUEST FOR INFORMATION:

The Contractor shall prepare and submit a Request For Information (RFI) in accordance with blocks 4 & 5 when requesting information or requesting a change to a contract requirement. Contractor shall submit an RFI as often as required.

NAVCRANECEN will provide a response within the negotiated response date.

The RFI shall be submitted electronically in .pdf file format. The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: The Contractor shall propose a response need date. Final need date shall be agreed upon with the NAVCRANECEN Project Manager.

9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

JEBLC

See Block 16

Physical Copy

ElectronicSee Block 16

J. DATE

16. REMARKS NAVCRANECEN

6. REQUIRING OFFICE

NAVCRANECEN

9. DISTRIBUTION

STATEMENT

4. AUTHORITY

DI-SESS-80639E/80640E/80642E as modified by NCC

5. CONTRACT REFERENCE

Para 4.13

a. ADDRESSEE

10. FREQUENCY

ASREQ

14. DISTRIBUTION

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT SUBM.

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

F. CONTRACTOR

3. SUBTITLE

A. CONTRACT LINE ITEM NO. B. EXHIBIT

0001 A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM

Request For Information

Exhibit A Page 6 of 25 Rev. 1

TDP TM X

LT

8. APPL CODE

A

0 1 1 1

1 0 1 0

0 0 2 0

5 2

H. DATE

9/23/2025

FINAL O&M CD-ROM

FINAL O&M PAPER

NAVCRANECEN

16. REMARKS PRE-FINAL O&M

NAVCRANECEN

JEBLC

JEBLC

JEBLC

NAVCRANECEN

PRE-FINAL O&M MANUAL (PAPER & ELECTRONIC):

Furnish pre-final paper and electronic copies of the technical manual in accordance with blocks 4 and 5 at the time of crane shipment. Paper copy manual shall be on site prior to beginning government inspection. NAVCRANECEN will determine acceptability within 10 business days after crane acceptance. All subsequent Government review periods shall be complete within 10 business days of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval of Pre-Final O&M Manual is required within 5 business day after crane acceptance.

FINAL O&M MANUAL (PAPER AND CD-ROM):

Upon Government approval of the Pre-Final Submission, provide the approved Final O&M Manual on CD-ROM and paper copy in accordance with blocks 4 and 5 no later than 20 business days after Pre-Final O&M Manual approval. Submit printed manuals and CD-ROM(s) via overnight private courier.

FINAL O&M MANUAL CD-ROM:

Provide data in PDF format, bookmarked as a minimum based on the manual information required by block 5.

FINAL O&M MANUAL PAPER:

Paper copies of the final manual shall be bound in durable, water-resistant, hard-cover binders and shall include the approved Final As-Built Drawings reduced in size to 11-in x 17-in.

NAVCRANECEN will determine acceptability within 10 business days after submittal.

All subsequent Government review periods shall be complete within 10 business days of receipt of resubmission.

3. SUBTITLE

One 100MT Mobile Boat Hoist

ElectronicPhysical Copy

6. REQUIRING OFFICE

NAVCRANECEN

a. ADDRESSEE

A

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

4. AUTHORITY

DI-TMSS-80527C

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT

5. CONTRACT REFERENCE

Para. 4.1, Para. 4.3, Para. 4.4, Para. 4.9

[N62470-25-R-0019]

1. DATA ITEM NO.

A004

2. TITLE OF DATA ITEM

Operations & Maintenance Manual

10. FREQUENCY

ASREQ

14. DISTRIBUTION

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT SUBM.

See Block 16

9. DISTRIBUTION

STATEMENT

See Block 16

9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

J. DATE

Exhibit A Page 7 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 1 1

1 2

H. DATE

9/23/2025

Physical Copy

Electronica. ADDRESSEE

NAVCRANECEN

JEBLC

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

F. CONTRACTOR

A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

A. CONTRACT LINE ITEM NO. B. EXHIBIT

1. DATA ITEM NO.

A005

2. TITLE OF DATA ITEM

Certification, Wire Rope

9. DISTRIBUTION

STATEMENT

4. AUTHORITY

DI-MISC-80678, para 10.3.2

5. CONTRACT REFERENCE

Para. 4.1, Para. 4.5, Para. 4.5.1

12. DATE OF FIRST SUBMISSION

See Block 16

6. REQUIRING OFFICE

NAVCRANECEN

3. SUBTITLE

14. DISTRIBUTION

J. DATE

9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

10. FREQUENCY

ONE/R

16. REMARKS

11. AS OF DATE 13. DATE OF SUBSEQUENT SUBM.

See Block 16

WIRE ROPE CERTIFICATION:

Provide data a minimum of 10 business days prior to self test in accordance with blocks 4 and 5. NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval is required a minimum of 1 business day prior to shipment of the crane.

Exhibit A Page 8 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 1 1

1 2

H. DATE

9/23/2025

SLING LOAD TEST CERTIFICATION:

Provide slings' load (proof) test report data a minimum of 25 business days prior to self test in accordance with blocks 4 and 5. NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

Report shall clearly provide the name of manufacturer, the link or ring's unique serial number, the working load limit, proof load, and hold duration.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval of submitted sling report with all required supporting documentation is required a minimum of 10 business days prior to shipment of crane.

15. TOTAL

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

J. DATE

9/23/2025

16. REMARKS NAVCRANECEN

JEBLC

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT

0001 A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

1. DATA ITEM NO.

A009

2. TITLE OF DATA ITEM

Certification, Slings

DI-MISC-80678, para 10.3.2

5. CONTRACT REFERENCE

Para. 3.2.2.3 Para. 4.1, Para. 4.5.3

10. FREQUENCY

NAVCRANECEN

9. DISTRIBUTION

STATEMENT

4. AUTHORITY

a. ADDRESSEEONE/R

14. DISTRIBUTION

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT SUBM.

See Block 16

Physical Copy

See Block 16 Electronic

F. CONTRACTOR

3. SUBTITLE

6. REQUIRING OFFICE

Exhibit A Page 9 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 0 1

0 2

H. DATE

9/23/2025

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

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

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

0001 A

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

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

A010 Certification, Contractor's Self Test

4. AUTHORITY 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTI-80809B Para. 4.1, Para. 4.15.1 Para. 4.15.2 NAVCRANECEN

9. DISTRIBUTION

STATEMENT

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

ONE/R See Block 16 a. ADDRESSEE Physical Copy

Electronic

11. AS OF DATE 13. DATE OF SUBSEQUENT SUBM.

See Block 16

16. REMARKS NAVCRANECEN

15. TOTAL

G. PREPARED BY I. APPROVED BY

CERTIFICATION OF CONTRACTOR'S SELF TEST:

Provide the completed contractor's self test within 5 business days of completion of test, and prior to crane shipment, in accordance with blocks 4 and 5. NAVCRANECEN will determine acceptability within 2 business days after receipt. All subsequent Government review periods shall be complete within 2 business days of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval of Certification of Contractor Self Test is required prior to shipment of the crane.

JEBLC

J. DATE

Brittany Copeland Christopher Halligan 9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

Exhibit A Page 10 of 25 Rev. 1

LT

8. APPL CODE

A

0 1 0 1

0 1 0 1

0 1 0 1

0 1 0 1

0 1 1 1

1 10

H. DATE

9/23/2025

JEBLC

Physical Copy

Electronic

F. CONTRACTOR

3. SUBTITLE

NAVCRANECEN

6. REQUIRING OFFICE

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

A. CONTRACT LINE ITEM NO. B. EXHIBIT

See Block 16

See Block 16

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

1. DATA ITEM NO.

A011

2. TITLE OF DATA ITEM

Test Procedures and Reports

NAVCRANECEN

4. AUTHORITY

DI-NDTI-80809B, DI-QCIC-81110

5. CONTRACT REFERENCE

a. ADDRESSEE

10. FREQUENCY

ONE/R

14. DISTRIBUTION9. DISTRIBUTION

STATEMENT

Para. 4.1, Para. 4.15.1, Para. 4.15.2, Para. 4.15.3, Para 4.15.4,Appendix B, Appendix C

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT SUBM.

J. DATE

9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

15. TOTAL

16. REMARKS

SELF TEST PROCEDURE:

Provide Self Test Procedure for review at least 25 business days prior to self test in accordance with blocks 4 and 5. NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

SELF TEST RECORD:

Completed Self Test Record shall be submitted within 5 business days of completion of test, and prior to crane shipment. NAVCRANECEN will determine acceptability within 2 business days after receipt. All subsequent Government review periods shall be complete within 2 business days of receipt of resubmission.

REQUEST TO SHIP:

Request to Ship shall be submitted at least 2 business days prior to crane shipment. NAVCRANECEN will determine acceptability within 1 business day after receipt. All subsequent Government review periods shall be complete within 1 business day after resubmission.

NOTIFICATION OF GOVERNMENT FIELD INSPECTION:

Notify Government of projected Contractor's inspection test completion date 5 business days prior to expected completion. Notify Government immediately after Contractor's preliminary inspection and test is complete.

FIELD TEST RECORD:

Completed Field Test Record shall be submitted within 3 business days of completion of test.

NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

Note: The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation. Government approval of Contractor developed Self Test Procedure is required a minimum of 10 business days prior to self test. Government approval of Self Test Record and Request to Ship is required prior to crane shipment. Government approval of Field Test Record is required prior to crane acceptance.

NAVCRANECEN

JEBLC

NAVCRANECEN

JEBLC

NAVCRANECEN

JEBLC

SHOP TEST PROCEDURE

SHOP TEST RECORD &

DEFICIENT ITEMS LIST

REQUEST TO SHIP &

UPDATED DEFICIENT ITEMS

NOTIFICATION OF

GOVERNMENT FIELD

FIELD TEST RECORD

JEBLC

NAVCRANECEN

Exhibit A Page 11 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 0 1

0 2

H. DATE

9/23/2025 9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

J. DATE

15. TOTAL

16. REMARKS

MBH RE-ASSEMBLY PLAN:

Provide a detailed re-assembly/installation lift and rigging plan in accordance with blocks 4 and 5 a minimum of 15 business days prior to Pre-installation Conference, but no later than 25 business days prior to mobilization should the conference be delayed.

NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval required by earlier event of 2 business days prior to crane shipment or 5 business days prior to desired entry of Contractor mobile crane or material handling equipment.

a. ADDRESSEE

10. FREQUENCY

ONE/R

14. DISTRIBUTION9. DISTRIBUTION

STATEMENT

Physical Copy

ElectronicSee Block 16

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT SUBM.

See Block 16

6. REQUIRING OFFICE4. AUTHORITY

OT-24206

5. CONTRACT REFERENCE

Para. 4.1, Para. 4.17, Appendix H, Appendix E

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

1. DATA ITEM NO.

A012

2. TITLE OF DATA ITEM

MBH Re-assembly Plan

F. CONTRACTOR

3. SUBTITLE

NAVCRANECEN

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT

0001 A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

NAVCRANECEN

Exhibit A Page 12 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 1 1

1 2

H. DATE

9/23/2025 9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

J. DATE

15. TOTAL

16. REMARKS

ACCIDENT PREVENTION PLAN:

Provide an Accident Prevention Plan (APP) written by the contractor for the specific work and hazards of the contract and in accordance with blocks 4 and 5. Submit a minimum of 15 business days prior to Pre-installation Conference, but no later than 25 business days prior to mobilization should the conference be delayed.

NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

Prior to submission of the APP, the contractor and subcontractors shall meet with representatives of the Contracting Officer to discuss and develop a mutual understanding relative to administration of the overall safety program.

The APP should contain blank sign in sheets for the briefings held prior to each unique feature of work. A hardcopy of the APP shall be present on the worksite at all times.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government acceptance required prior to mobilization at site and crane shipment.

a. ADDRESSEE

10. FREQUENCY

ONE/R

14. DISTRIBUTION9. DISTRIBUTION

STATEMENT

Physical Copy

ElectronicSee Block 16

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT SUBM.

See Block 16

6. REQUIRING OFFICE4. AUTHORITY

OT-24206

5. CONTRACT REFERENCE

Para. 4.1, Para. 4.6, Appendix E

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

1. DATA ITEM NO.

A013

2. TITLE OF DATA ITEM

Accident Prevention Plan

F. CONTRACTOR

3. SUBTITLE

NAVCRANECEN

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT

0001 A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

NAVCRANECEN

Exhibit A Page 13 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 1 1

1 2

H. DATE

9/23/2025 9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

J. DATE

15. TOTAL

16. REMARKS

PROPERTY TRANSFER VERIFICATION:

Provide Property Transfer Verification in accordance with blocks 4 and 5 submitted at crane acceptance.

Property Transfer Verification shall be completed on NCC-provided 'Property Transfer Form' with printed name, phone number, signature and date received provided by both the Contractor Representative and Supported Command Representative.

NAVCRANECEN will determine acceptability within 2 business days after receipt. All subsequent Government review periods shall be complete within 1 business day of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation under 'Property Transferred' section along with a description of the items provided.

Note: Government approval is required prior to crane acceptance.

a. ADDRESSEE

10. FREQUENCY

ONE/R

14. DISTRIBUTION9. DISTRIBUTION

STATEMENT

Physical Copy

ElectronicSee Block 16

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT SUBM.

See Block 16

6. REQUIRING OFFICE4. AUTHORITY

DI-MISC-80678, para 10.3.2

5. CONTRACT REFERENCE

Para. 4.1, Para. 4.12

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

1. DATA ITEM NO.

A016

2. TITLE OF DATA ITEM

Property Transfer Verification

F. CONTRACTOR

3. SUBTITLE

NAVCRANECEN

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT

0001 A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

NAVCRANECEN

Exhibit A Page 14 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 0 0

0 1

H. DATE

9/23/2025 9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY

Brittany Copeland

I. APPROVED BY

Christopher Halligan

J. DATE

15. TOTAL

16. REMARKS

POST-AWARD CONFERENCE MINUTES:

The contractor shall prepare and submit meeting minutes for the Post-Award Conference. Provide data in accordance with blocks 4 and 5 within 5 business days after conference.

PRE-INSTALLATION CONFERENCE MINUTES:

The contractor shall prepare and submit meeting minutes for the Pre-Installation Conference. Provide data in accordance with blocks 4 and 5 within 5 business days after conference.

NAVCRANECEN will determine acceptability within 5 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

a. ADDRESSEE

10. FREQUENCY

ASREQ

14. DISTRIBUTION9. DISTRIBUTION

STATEMENT

Physical Copy

ElectronicSee Block 16

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT SUBM.

See Block 16

6. REQUIRING OFFICE4. AUTHORITY

DI-ADMIN-81250B

5. CONTRACT REFERENCE

Para. 2.5.1, Para. 2.5.2, Para. 4.1

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

1. DATA ITEM NO.

A017

2. TITLE OF DATA ITEM

Conference Minutes

F. CONTRACTOR

3. SUBTITLE

NAVCRANECEN

Form Approved OMB No. 0704-0188

C. CATEGORY

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT

0001 A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

NAVCRANECEN

Exhibit A Page 15 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 0 1

0 2

H. DATE

9/23/2025

J. DATE

Brittany Copeland Christopher Halligan 9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

15. TOTAL

G. PREPARED BY I. APPROVED BY

CONTRACTOR MOBILE CRANE ENTRY PACKAGE:

Provide complete contractor mobile crane entry package in accordance with blocks 4 and 5 required by earlier event of either as directed by Appendix H paragraph 10.1 or 5 business days prior to desired entry of a Contractor owned mobile crane to the Government job-site.

The MBH Re-assembly/Installation Plan is a part of this entry package and requires approval prior to inclusion and forwarding of the Contractor Mobile Crane Entry Package to the Supported Command.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval required prior to mobile crane entry inspection.

JEBLC

16. REMARKS NAVCRANECEN

9. DISTRIBUTION

STATEMENT

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

ONE/R See Block 16 a. ADDRESSEE Physical Copy

Electronic

13. DATE OF SUBSEQUENT SUBM.

See Block 16

11. AS OF DATE

4. AUTHORITY 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

OT-24206

Para. 4.1, Para. 4.14; Appendix E, Appendix H NAVCRANECEN

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

A018 Contractor Mobile Crane Entry Package

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

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

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

0001 A

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

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

Exhibit A Page 16 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 1 1

1 2

H. DATE

9/23/2025

15. TOTAL

G. PREPARED BY I. APPROVED BY J. DATE

Brittany Copeland Christopher Halligan 9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete

TRAINING COURSE OUTLINE:

Provide a training course outline in accordance with blocks 4 and 5 a minimum of 10 business days prior to crane shipment. NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval required before installation of the crane.

16. REMARKS NAVCRANECEN

JEBLC

9. DISTRIBUTION

STATEMENT

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

ONE/R See Block 16 a. ADDRESSEE Physical Copy

Electronic

11. AS OF DATE 13. DATE OF SUBSEQUENT SUBM.

See Block 16

4. AUTHORITY 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-ILSS-81075 as modified by NCC Para. 4.1, Para. 4.8, Para. 4.8.1 NAVCRANECEN

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

A020 Training Course Outline

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

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

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

0001 A

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

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

Exhibit A Page 17 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 1 1

2 2

H. DATE

9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

15. TOTAL

G. PREPARED BY I. APPROVED BY J. DATE

Brittany Copeland Christopher Halligan 9/23/2025

16. REMARKS NAVCRANECEN

JEBLC

9. DISTRIBUTION

STATEMENT

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

ONE/R See Block 16 a. ADDRESSEE Physical Copy

Electronic

11. AS OF DATE 13. DATE OF SUBSEQUENT SUBM.

See Block 16

FREQUENCY ALLOCATION APPLICATION:

Provide Frequency Allocation Application in accordance with blocks 4 and 5 a minimum of 10 business days prior to self testing. NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval required prior to crane acceptance.

4. AUTHORITY 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MISC-80678, para 10.3.2 Para. 4.1, Para. 4.7 NAVCRANECEN

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

A022 Frequency Allocation Application

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

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

0001 A

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

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

Exhibit A Page 18 of 25 Rev. 1

LT

8. APPL CODE

A 0 1 1 1

1 2

H. DATE

9/23/2025Brittany Copeland Christopher Halligan 9/23/2025 DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1

G. PREPARED BY I. APPROVED BY

PUBLIC DOMAIN SOFTWARE CERTIFICATION:

Provide certification in accordance with blocks 4 and 5 a minimum of 25 business days prior to self test. NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval is required prior to crane shipment.

JEBLC

J. DATE

15. TOTAL

11. AS OF DATE 13. DATE OF SUBSEQUENT SUBM.

See Block 16

16. REMARKS NAVCRANECEN

4. AUTHORITY 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MISC-80678, DI-AVCS-80700A Para. 4.1, Para. 4.5.6 NAVCRANECEN

9. DISTRIBUTION

STATEMENT

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

ONE/R See Block 16 a. ADDRESSEE Physical Copy

Electronic

F. CONTRACTOR

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

A025 Certification, Public Domain Software

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

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

Public reporting burden for this 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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

0001 A

D. SYSTEM/ITEM E. CONTRACT/PR NO.

Exhibit A Page 19 of 25 Rev. 1

LT

8. APPL CODE

A

0 1 0 1

1 0 1 0

2 2

H. DATE

9/23/2025

G. PREPARED BY I. APPROVED BY

DD Form 1423-1, JUN 90 Previous editions are obsolete

PRE-FINAL COMPUTER DOCUMENTATION:

Provide data in accordance with blocks 4 and 5 a minimum of 25 business days prior to self test. NAVCRANECEN will determine acceptability within 10 business days after receipt. All subsequent Government review periods shall be complete within 5 business days of receipt of resubmission.

The crane serial number, contract number, CDRL number, and CLIN number shall be included on submitted documentation.

Note: Government approval of Pre-Final Computer Documentation is required prior to crane acceptance.

FINAL CD-ROM COMPUTER DOCUMENTATION:

Upon Government approval of Pre-Final Computer Documentation submission, provide data on CD-ROM via private courier in accordance with blocks 4 and 5 no later than 30 calendar days after acceptance of the crane. NAVCRANECEN will determine acceptability within 10 business days after submittal. All subsequent Government review periods shall be complete within 10 business days of receipt of resubmission.

NAVCRANECEN

JEBLC

FINAL CD-ROM VERSION

J. DATE

Brittany Copeland Christopher Halligan 9/23/2025

15. TOTAL

11. AS OF DATE 13. DATE OF SUBSEQUENT SUBM.

See Block 16

16. REMARKS

JEBLC

PRE-FINAL SUBMISSION

NAVCRANECEN

4. AUTHORITY 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-AVCS-80700A

Para. 4.1, Para. 4.5, Para. 4.5.6, Para.

4.5.7, Para. 4.18-4.24 NAVCRANECEN

9. DISTRIBUTION

STATEMENT

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

ONE/R See Block 16 a. ADDRESSEE Physical Copy

Electronic

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

A026 Computer Documentation

One 100MT Mobile Boat Hoist [N62470-25-R-0019]

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

Public reporting burden for this 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.