CDRL_A001_FCP_CALCert_CDM_Cert_061416.doc
DOC document 80 KB Posted
- Attached to
- Force Calibration Press
- Solicitation number
- N64267-16-R-0113
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CDRL A001 FCP CAL Cert CDM
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Text version
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item) Form Approved
OMB No. 0704-0188
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 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: |
| TBD |
| A |
| TDP________ |
| TM _______ |
| OTHER QCIC |
| D. SYSTEM/ITEM |
| E. CONTRACT/PR NO. |
| F. CONTRACTOR |
| Force Calibration Press |
| N64267-16-R-XXXX |
| TBD |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A001 |
| CALIBRATION CERTIFICATE |
| Certificate of Calibration |
II
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
DI-QCIC-80798B
(See Block 16) SOW Paragraph: 4.5 (See Block 16)
NAVAIRLKE 41L400B
TOTAL PRICE
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10. FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
LT
ASGEN
(See Block 16)
(See Block 16)
A
(See Block 16)
b. COPIES
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT SUBMISSION |
| a. ADDRESSEE |
Final
N/A
| N/A |
| ASREQ |
(See Block 16)
| Draft |
| Reg. |
| Repro |
| 16. REMARKS |
| Pat Brannick 41L400B |
| 0 |
| 1 |
| 0 |
Block 4/5: DI-QCIC-80798B and SOW specification paragraph 4.5 shall be used as guidance and are provided as reference. Data points from the actual calibration must be included with this report. Requirement items listed in DI-QCIC-80798B that are not relevant to this procurement need not be included in the format.
Block 10: Frequency of Certificate of Calibration (CDRL A001 subtitle) shall be provided as generated for each unit calibrated.
Block 12: Date of first submission shall be in accordance with (IAW) first unit calibrated.
Block 13: Date of subsequent submissions shall be IAW each unit returned to the government after subsequent calibration is performed.
Block 14: Submission in contractor format is acceptable. Electronic format is preferred if in a widely available commercial document format such as MS-Excel or MS Word. Electronic submission of data is also accepted on CD-ROM. Quantity and copies shall be provided IAW CDRL distribution (Block 14). Addressee's POC information provided on CDRL supplemental page 2.
| With each unit shipped |
| 0 |
| 1 |
| 0 |
| 15. TOTAL |
| 0 |
| 2 |
| 0 |
G. PREPARED BY
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| P. Brannick, NAVAIRLKE 4.1.12.4 |
| 03/02/2016 |
| //s//K. Bergland, NSWC Corona Div MSD CDM |
| 06/14/2016 |
DD Form 1423-1 JUN 90 Previous editions are obsolete.
Page 1 of 2 Pages DD FORM 1423 (CDRL) Supplemental
BLOCK 14 ENTRY COMPLETE ADDRESS
Patrick Brannick, patrick.brannick@navy.mil
NAWCAD 4.1.12.4
JB MDL
Highway 547, Building 120-3, Rm. 269
Lakehurst, NJ 08733 Page 2 of 2 Pages
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