Attachments_1_thru_5.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

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

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

A

MGMT

MCIWEST Generator PR = 1300551605 TBD

A001 Government Furnished Inspection Equipment Maintenance Report

Emergency Repair Report (ERR)

DI-MGMT-80277 SOW 5.2, 6 NSCW Corona Division

LT

A See Block 16

ASREQ

N/A

See Block 16

See Block 16

RS31 1 2

1 2 0

Block 8: Approval for technical content and format. Government has 5 days to review. Contractor has 5 days to incorporate comments and resubmit.

Block 9: Affix the following distribution statement on all documents;

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors, Administrative and Operational Use, 1 October 2005. Other requests for this document shall be referred to Naval Surface Warfare Center, Corona Division, Attn: Phil Pratt, RS31, P.O. Box 5000 Corona, CA 92878-5000."

Block 10: When maintenance and/or repair tasks are performed an ERR shall be submitted.

Block 12: The contractor shall notify the POC's before any emergency repair. A detailed report shall be within 5 business days.

Block 13: The contractor shall notify the POC's before any emergency repair. A detailed report shall be submitted within 5 business days.

Block 14: Maintenance Procedures shall be submitted digitally via email in either Microsoft Word and/or Microsoft Excel as is appropriate.

Block 14a: Electronic copies to be sent to below emails for Government representative QA acceptance:

evette.vartanian@navy.mil phillip.pratt@navy.mil

7/13/2016

OLEA.MARIA.M.

1251908121

Digitally signed by OLEA.MARIA.M.1251908121 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN, cn=OLEA.MARIA.M.1251908121 Date: 2016.07.14 10:37:21 -07'00'

7/14/2016

1 1

PRATT.PHILLIP.1

224419747

Digitally signed by PRATT.PHILLIP.1224419747 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN, cn=PRATT.PHILLIP.1224419747 Date: 2016.07.13 15:33:54 -07'00'

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

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

TDP ________ TM _______ OTHER

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

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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

A

MGMT

MCI WEST Generator PR = 1300551605 TBD

A002 Government Furnished Inspection Equipment Maintenance Report

Maintenance Report (MR)

DI-MGMT-80277 SOW 5.2, 5.3, 6.2 NSWC Corona Division

LT

A See Block 16

ASREQ

N/A

See Block 16

See Block 16

RS31 1 2

1 2 0

Block 8: Approval for technical content and format. Government has 5 days to review. Contractor has 5 days to incorporate comments and resubmit.

Block 9: Affix the following distribution statement on all documents;

"DISTRIBUTION STATEMENT C: Distribution authorized to U.S. Government Agencies and their contractors, Administrative and Operational Use, 1 October 2005. Other requests for this document shall be referred to Naval Surface Warfare Center, Corona Division, Attn: Phil Pratt, RS31, P.O. Box 5000 Corona, CA 92878-5000."

Block 10: When maintenance and/or repair tasks are performed, a MR shall be submitted.

Block 12: Within 5 business days of first scheduled maintenance. Block 13: Within 5 business days of each scheduled maintenance.

Block 14: Maintenance Procedures shall be submitted digitally via email in either Microsoft Word and/or Microsoft Excel as is appropriate.

Block 14a: Electronic copies to be sent to below emails for Gov representative QA acceptance:

evette.vartanian@navy.mil phillip.pratt@navy.mil

07/08/16

OLEA.MARIA.M.

1251908121

Digitally signed by OLEA.MARIA.M.1251908121 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN, cn=OLEA.MARIA.M.1251908121 Date: 2016.07.08 16:15:30 -07'00'

07/08/2016

1 1

PRATT.PHILLIP.1

224419747

Digitally signed by PRATT.PHILLIP.1224419747 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN, cn=PRATT.PHILLIP.1224419747 Date: 2016.07.08 15:54:57 -07'00'

APPENDIX A

CONTRACT DISCREPANCY REPORT

DATE AND TIME:

CONTRACT NUMBER:

CONTRACTOR:

SITE:

DESCRIPTION OF DISCREPANCY: (reference SOW/Directive)

DATE(S) OF VERBAL NOTIFICATION:

ORIGINATOR’S SIGNATURE:

ABOVE PORTION OF FORM IS TO BE FILLED OUT BY COR OR ACOR

CONTRACTOR’S RESPONSE AS TO CAUSE, CORRECTIVE ACTION, AND ACTION(S) TO

PREVENT RECURRENCE. CITE APPLICABLE QA PROGRAM PROCEDURES OR NEW QA

PROCEDURES:

SIGNATURE OF CONTRACTOR REPRESENTATIVE:

DATE:

ABOVE PORTION TO BE FILLED OUT BY CONTRACTOR

GOVERNMENT EVALUATION (ACCEPTANCE, PARTIAL ACCEPTANCE, REJECTION):

CLOSE OUT (TO BE FILLED OUT WHEN DISCREPANCY HAS BEEN SATISFACTORILY SOLVED):

FUNCTION

NAME/TITLE

SIGNATURE DATE

ORIGINATOR

CONTRACTOR