J-1 - Contract Data Requirements List_DD Form 1423_A001 through A066.pdf

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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:

TDP TM OTHER

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

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE

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

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL ▬▬▬▬►

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page of Pages

A CONTRACT LINE ITEM NO: TBD

B EXHIBIT: A

D SYSTEMITEM: COMMON DISPLAY SYSTEM

E CONTRACTPR NO: N63394-19-R-0013

F CONTRACTOR: TBD

1 DATA ITEM NO: A028

2 TITLE OF DATA ITEM: Technical Report - Study/Services

3 SUBTITLE: DMSMS Health Analysis Report

17 PRICE GROUP: N/A

4 AUTHORITY Data Acquisition Document No: DI-MISC-80508B (SEE BLK 16)

5 CONTRACT REFERENCE: SOW PARA 5.3.6

6 REQUIRING OFFICE: NSWC PHD A43

7 DD 250 REQ: LT

8 APP CODE: A (See BLK16)

9 DIST STATEMENT REQUIRED: D (SEE BLK 16)

10 FREQUENCY: ASREQ

12 DATE OF FIRST SUBMISSION: (SEE BLK 16)

11 AS OF DATE: N/A

H DATE: 16 Aug 2019 a ADDRESSEE16 REMARKS: NSWC PHD COR

Draft16 REMARKS: 0

Reg16 REMARKS: 1

Repro16 REMARKS: 0 a ADDRESSEE16 REMARKS_2: NSWC PHD A43

Draft16 REMARKS_2: 1

Reg16 REMARKS_2: 1

Repro16 REMARKS_2: 1 a ADDRESSEE16 REMARKS_3:

Draft16 REMARKS_3:

Reg16 REMARKS_3:

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Draft15 TOTAL: 1

Reg15 TOTAL: 2

J DATE: 16 Aug 2019

18 ESTIMATED TOTAL PRICE: NSP

Repro15 TOTAL: 1

Pages: 1

Page: 1

2019-08-16T10:59:37-0700

ENGELS.WILLIAM.ANDREW.1276635987

2019-08-16T12:08:10-0700

BLAU.ROBERT.C.1295540938

13 DATE IF SUBSEQUENT SUBM: (SEE BLK 16)

Remarks: BLK 4: Contractor format is acceptable.

BLK 8: Requiring office shall approve format and content.

BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to DOD and DOD contractors only; administrative or operational use; 11 Sep 2018. Other requests for this document shall be referred to NSWC PHD Code A40.

BLK 10, 12, 13: Draft due at PDR and CDR. Final due 30 calendar days after review comments received.

BLK 14: Media and Format: The deliverable shall be created using the latest NMCI compatible version of Microsoft Office. Deliverable shall be provided as an electronic mail attachment. If for any reason contractor determines the deliverable cannot be provided via electronic mail, the deliverable shall be provided on CD-ROM or DVD-ROM to NSWC PHD COR.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 -19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE CONTRACT, PURCHASE ORDER, ETC., USE OF GOVERNMENT DOCUMENTATION FOR COMMERCIAL PURPOSES IS FORBIDDEN.

C CATEGORY TDP TM OTHER: MISC

TM:

TDP:

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.

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

A CONTRACT LINE ITEM NO: 9999

B EXHIBIT: A

D SYSTEMITEM: COMMON DISPLAY SYSTEM

E CONTRACTPR NO: N63394-19-R-0013

F CONTRACTOR: TBD

1 DATA ITEM NO: A064

2 TITLE OF DATA ITEM: Technical Report - Study/Services

3 SUBTITLE: Emergency Action Plan

17 PRICE GROUP: N/A

4 AUTHORITY Data Acquisition Document No: DI-MISC-80508B

5 CONTRACT REFERENCE: SOW PARA 5.1.7

6 REQUIRING OFFICE: NSWC PHD A43

7 DD 250 REQ: LT

8 APP CODE: N/A

9 DIST STATEMENT REQUIRED: D (SEE BLK 16)

10 FREQUENCY: ASREQ

12 DATE OF FIRST SUBMISSION: (SEE BLK 16)

11 AS OF DATE: N/A

H DATE: 12 SEPT 2018

a ADDRESSEE16 REMARKS: NSWC PHD COR

Draft16 REMARKS: 0

Reg16 REMARKS: 1

Repro16 REMARKS: 0 a ADDRESSEE16 REMARKS_2:

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Draft15 TOTAL: 0

Reg15 TOTAL: 1

J DATE: 16 Aug 2019

18 ESTIMATED TOTAL PRICE: NSP

Repro15 TOTAL: 0

Pages: 1

Page: 1

2018-09-12T09:18:56-0700

WHIPPLE.ROBERT.R.1243852036

2019-08-16T19:30:20-0700

BLAU.ROBERT.C.1295540938

13 DATE IF SUBSEQUENT SUBM: (SEE BLK 16)

Remarks: BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to DOD and DOD contractors only; administrative or operational use; 11 SEP 2018. Other requests for this document shall be referred to NSWC PHD Code A40.

BLK 10, 12, 13: Reports shall be submitted 15 days after report of incident.

BLK 14: Media and Format: The deliverable shall be created using the latest NMCI compatible version of Microsoft Office. Deliverable shall be provided as an electronic mail attachment. If for any reason contractor determines the deliverable cannot be provided via electronic mail, the deliverable shall be provided on CD-ROM or DVD-ROM to NSWC PHD COR.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 -19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE CONTRACT, PURCHASE ORDER, ETC., USE OF GOVERNMENT DOCUMENTATION FOR COMMERCIAL PURPOSES IS FORBIDDEN.

C CATEGORY TDP TM OTHER: MISC

TM:

TDP:

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.

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

A CONTRACT LINE ITEM NO: 9999

B EXHIBIT: A

D SYSTEMITEM: COMMON DISPLAY SYSTEM

E CONTRACTPR NO: N63394-19-R-0013

F CONTRACTOR: TBD

1 DATA ITEM NO: A029

2 TITLE OF DATA ITEM: Scientific and Technical Reports

3 SUBTITLE: Risk Management Plan

17 PRICE GROUP: N/A

4 AUTHORITY Data Acquisition Document No: DI-MISC-80711A

5 CONTRACT REFERENCE: SOW PARA 5.2.7

6 REQUIRING OFFICE: NSWC PHD A43

7 DD 250 REQ: LT

8 APP CODE: N/A

9 DIST STATEMENT REQUIRED: D (SEE BLK 16)

10 FREQUENCY: ASREQ

12 DATE OF FIRST SUBMISSION: (SEE BLK 16)

11 AS OF DATE: N/A

H DATE: 11 SEPT 2018

a ADDRESSEE16 REMARKS: NSWC PHD COR

Draft16 REMARKS: 0

Reg16 REMARKS: 1

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Draft15 TOTAL: 0

Reg15 TOTAL: 1

J DATE: 16 Aug 2019

18 ESTIMATED TOTAL PRICE: NSP

Repro15 TOTAL: 0

Pages: 1

Page: 1

2018-09-11T13:35:43-0700

WHIPPLE.ROBERT.R.1243852036

2019-08-16T10:54:40-0700

BLAU.ROBERT.C.1295540938

13 DATE IF SUBSEQUENT SUBM: (SEE BLK 16)

Remarks: BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to DOD and DOD contractors only; administrative or operational use; Dec 2015. Other requests for this document shall be referred to NSWC PHD Code A40.

BLK 10, 12, 13: Due 30 days after completion of acceptance testing.

BLK 14: Media and Format: The deliverable shall be created using the latest NMCI compatible version of Microsoft Office. Deliverable shall be provided as an electronic mail attachment. If for any reason contractor determines the deliverable cannot be provided via electronic mail, the deliverable shall be provided on CD-ROM or DVD-ROM to NSWC PHD COR.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 -19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE CONTRACT, PURCHASE ORDER, ETC., USE OF GOVERNMENT DOCUMENTATION FOR COMMERCIAL PURPOSES IS FORBIDDEN.

C CATEGORY TDP TM OTHER: MISC

TM:

TDP:

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.

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

A CONTRACT LINE ITEM NO: 9999

B EXHIBIT: A

D SYSTEMITEM: COMMON DISPLAY SYSTEM

E CONTRACTPR NO: N63394-19-R-0013

F CONTRACTOR: TBD

1 DATA ITEM NO: A033

2 TITLE OF DATA ITEM: Planned Maintenance System (PMS) Maintenance Index Page (MIP)

3 SUBTITLE: Planned Maintenance System (PMS) Maintenance Requirement Card (MRC)

17 PRICE GROUP: N/A

4 AUTHORITY Data Acquisition Document No: DI-PSSS-80992B

5 CONTRACT REFERENCE: SOW PARA 5.9.1

6 REQUIRING OFFICE: NSWC PHD A43

7 DD 250 REQ: LT

8 APP CODE: N/A

9 DIST STATEMENT REQUIRED: D (SEE BLK 16)

10 FREQUENCY: ASREQ

12 DATE OF FIRST SUBMISSION: (SEE BLK 16)

11 AS OF DATE: N/A

H DATE: 11 SEPT 2018

a ADDRESSEE16 REMARKS: NSWC PHD COR

Draft16 REMARKS: 0

Reg16 REMARKS: 1

Repro16 REMARKS: 0 a ADDRESSEE16 REMARKS_2:

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Draft15 TOTAL: 0

Reg15 TOTAL: 1

J DATE: 16 Aug 2019

18 ESTIMATED TOTAL PRICE: NSP

Repro15 TOTAL: 0

Pages: 1

Page: 1

2018-09-11T13:49:16-0700

WHIPPLE.ROBERT.R.1243852036

2019-08-16T13:24:49-0700

BLAU.ROBERT.C.1295540938

13 DATE IF SUBSEQUENT SUBM: (SEE BLK 16)

Remarks: BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to DOD and DOD contractors only; administrative or operational use; 11 SEP 2018. Other requests for this document shall be referred to NSWC PHD Code A40.

BLK 10, 12, 13: Due NLT 30 days after completion of acceptance testing.

BLK 14: Media and Format: The deliverable shall be created using the latest NMCI compatible version of Microsoft Office. Deliverable shall be provided as an electronic mail attachment. If for any reason contractor determines the deliverable cannot be provided via electronic mail, the deliverable shall be provided on CD-ROM or DVD-ROM to NSWC PHD COR.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 -19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE CONTRACT, PURCHASE ORDER, ETC., USE OF GOVERNMENT DOCUMENTATION FOR COMMERCIAL PURPOSES IS FORBIDDEN.

C CATEGORY TDP TM OTHER: PSSS

TM:

TDP:

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

PREVIOUS EDITION MAY BE USED.

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.

TDP ________ TM _______ OTHER

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

9. DIST STATEMENT

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

15. TOTAL

17. PRICE GROUP

18. ESTIMATED

Page of Pages

CONTRACT DATA REQUIREMENTS LIST

TDP ________ TM _______ OTHER

16. REMARKS (Continued)

DD FORM 1423-1, FEB 2001 Page of Pages

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package;

TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15.

Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.

DD FORM 1423-1 (BACK), FEB 2001

data_item: A065 title: REVISIONS TO EXISTING GOVERNMENT DOCUMENTS sub: NSWC PHD CONTRACTOR PERSONNEL ROSTER auth: DI-ADMN-80925A ref: SOW PARA 5.1.6 req_ofc: NSWC PHD A43 dd250: LT appcode: N/A dist: D(SEE BLK 16) freq: ASREQ asof: N/A firstsub: SEE BLK 16 subsub: SEE BLK 16 addressee1: SEE BLK 16 draft1:

reg1:

repro1:

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total_draft: 0 total_reg: 4 total_repro: 0 remarks: Block 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only. Administrative or Operational Use; 01-08-2019. Other requests for this document shall be referred to NSWC PHD Code 02.

Blocks 10 and 13: The contractor shall submit this data item via secure method prior to implementation of any changes to the roster. This includes any addition, change, or removal of contractor personnel performing under this contract.

Block 12: First submission via encrypted email shall be no later than seven calendar days after incorporation of the CDRL into the contract.

BLK 14: Media and Format: The deliverable shall be created using the latest NMCI compatible version of Microsoft Office. Contractor shall submit personnel roster in attached Microsoft Excel format. All data fields shall be included, or marked not applicable (“N/A”). Email addresses of recipients are as follows:

COR: See Contracting Officer’s Representative listed in Section G of the contract (contract clause HQ G-2-0003). KO: See Purchasing Office Representative listed in Section G of the contract (contract clause HQ G-2-0004).

NSWC PHD 02B: nicholas.deselle@navy.mil NSWC PHD 02T: cassandra.randolph@navy.mil

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 -19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE CONTRACT, PURCHASE ORDER, ETC., USE OF GOVERNMENT DOCUMENTATION FOR COMMERCIAL PURPOSES IS FORBIDDEN.

group: NSP total_price: N/A prep_name:

line_item: 9999 exhibit: A xtdp: Off xtm: Off othercat: ADMIN system: COMMON DISPLAY SYSTEM ctr_no: N63394-19-R-0013 contr: TBD remarksb:

Page2:

Reset:

2019-08-16T08:52:53-0700

ENGELS.WILLIAM.ANDREW.1276635987

prep_date: 16 AUG 2019 app_by:

2019-08-19T13:40:37-0700

BLAU.ROBERT.C.1295540938

app_date: 19 Aug 2019

Page: 1 of_pages: 1 app: Adobe Professional 8.0

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.

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

A CONTRACT LINE ITEM NO: TBD

B EXHIBIT: A

D SYSTEMITEM: COMMON DISPLAY SYSTEM

E CONTRACTPR NO: N63394-19-R-0013

F CONTRACTOR: TBD

1 DATA ITEM NO: A034

2 TITLE OF DATA ITEM: Planned Maintenance System (PMS) Maintenance Requirements Card (MRC)

3 SUBTITLE:

17 PRICE GROUP: N/A

4 AUTHORITY Data Acquisition Document No: DI-PSSS-80991B

5 CONTRACT REFERENCE: SOW PARA 5.9.1

6 REQUIRING OFFICE: NSWC PHD A43

7 DD 250 REQ: LT

8 APP CODE: N/A

9 DIST STATEMENT REQUIRED: D (SEE BLK 16)

10 FREQUENCY: ASREQ

12 DATE OF FIRST SUBMISSION: (SEE BLK 16)

11 AS OF DATE: N/A

H DATE: 27 JUN 2018

a ADDRESSEE16 REMARKS: NSWC PHD COR

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Reg16 REMARKS: 1

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Draft15 TOTAL: 0

Reg15 TOTAL: 1

J DATE: 16 Aug 2019

18 ESTIMATED TOTAL PRICE: NSP

Repro15 TOTAL: 0

Pages: 1

Page: 1

2018-09-18T07:19:08-0700

WHIPPLE.ROBERT.R.1243852036

2019-08-16T13:29:40-0700

BLAU.ROBERT.C.1295540938

13 DATE IF SUBSEQUENT SUBM: (SEE BLK 16)

Remarks: BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to DOD and DOD contractors only; administrative or operational use; 11 SEP 2018. Other requests for this document shall be referred to NSWC PHD Code A40.

BLK 10, 12, 13: Due NLT 30 days after completion of acceptance testing.

BLK 14: Media and Format: The deliverable shall be created using the latest NMCI compatible version of Microsoft Office. Deliverable shall be provided as an electronic mail attachment. If for any reason contractor determines the deliverable cannot be provided via electronic mail, the deliverable shall be provided on CD-ROM or DVD-ROM to NSWC PHD COR.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 -19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE CONTRACT, PURCHASE ORDER, ETC., USE OF GOVERNMENT DOCUMENTATION FOR COMMERCIAL PURPOSES IS FORBIDDEN.

C CATEGORY TDP TM OTHER: PSSS

TM:

TDP:

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.

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

A CONTRACT LINE ITEM NO: 9999

B EXHIBIT: A

D SYSTEMITEM: COMMON DISPLAY SYSTEM

E CONTRACTPR NO: N63394-19-R-0013

F CONTRACTOR: TBD

1 DATA ITEM NO: A030

2 TITLE OF DATA ITEM: Technical Report - Study/Services

3 SUBTITLE: Failure Reporting, Analysis and Corrective Action Technical Report

17 PRICE GROUP: N/A

4 AUTHORITY Data Acquisition Document No: DI-MISC-80508B

5 CONTRACT REFERENCE: (SEE BLK 16)

6 REQUIRING OFFICE: NSWC PHD A43

7 DD 250 REQ: LT

8 APP CODE: N/A

9 DIST STATEMENT REQUIRED: D (SEE BLK 16)

10 FREQUENCY: ASREQ

12 DATE OF FIRST SUBMISSION: (SEE BLK 16)

11 AS OF DATE: N/A

H DATE: 11 SEPT 2018

a ADDRESSEE16 REMARKS: NSWC PHD COR

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J DATE: 11 Aug 2019

18 ESTIMATED TOTAL PRICE: NSP

Repro15 TOTAL: 0

Pages: 1

Page: 1

2018-09-11T13:38:45-0700

WHIPPLE.ROBERT.R.1243852036

2019-08-16T11:02:42-0700

BLAU.ROBERT.C.1295540938

13 DATE IF SUBSEQUENT SUBM: (SEE BLK 16)

Remarks: BLK 5: SOW PARA: 5.5.4.3, 5.5.1, 5.5.2, 5.5.3, 5.5.4

BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to DOD and DOD contractors only; administrative or operational use; 11 Sep 2018. Other requests for this document shall be referred to NSWC PHD Code A40.

BLK 10, 12, 13: Due NLT 30 days after completion of acceptance testing.

BLK 14: Media and Format: The deliverable shall be created using the latest NMCI compatible version of Microsoft Office. Deliverable shall be provided as an electronic mail attachment. If for any reason contractor determines the deliverable cannot be provided via electronic mail, the deliverable shall be provided on CD-ROM or DVD-ROM to NSWC PHD COR.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - For classified documents, follow the procedures in DoD 5220.22-M, Industrial Security Manual, Section 11 -19 or DoD 5200.1-R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

GOVERNMENT DOCUMENTATION SHALL BE DESTROYED UPON COMPLETION OF THE CONTRACT, PURCHASE ORDER, ETC., USE OF GOVERNMENT DOCUMENTATION FOR COMMERCIAL PURPOSES IS FORBIDDEN.

C CATEGORY TDP TM OTHER: MISC

TM:

TDP:

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.

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

A CONTRACT LINE ITEM NO: 9999

B EXHIBIT: A

D SYSTEMITEM: COMMON DISPLAY SYSTEM

E CONTRACTPR NO: N63394-19-R-0013

F CONTRACTOR: TBD

1 DATA ITEM NO: A066

2 TITLE OF DATA ITEM: TEST PLANS/TEST PROCEDURES

3 SUBTITLE: PRODUCTION ACCEPTANCE TEST

(PAT) PROCEDURES

17 PRICE GROUP: NSP

4 AUTHORITY Data Acquisition Document No: Dl-SESS-81704 (SEE BLK 16)

5 CONTRACT REFERENCE: SOW PARA 5.8.1 5.8.2

6 REQUIRING OFFICE: NSWC PHD A43

7 DD 250 REQ: LT

8 APP CODE: A (SEE BLK 16)

9 DIST STATEMENT REQUIRED: D (SEE BLK 16)

10 FREQUENCY: ASREQ

12 DATE OF FIRST SUBMISSION: (SEE BLK 16)

11 AS OF DATE: N/A

H DATE: 19 SEPT 2018

a ADDRESSEE16 REMARKS: NSWC PHD COR

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