MS31_CDRL_A001_Certificate_of_Completion_signed_ts.pdf

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 the 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 Contractor Officer for the Contract/PR No. Listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT

A

C. CATEGORY:

TDP _________ TM- _________ OTHER PSSS

D. SYSTEM / ITEM

Oxygen Cleaning School

E. CONTRACT / PR NO.

TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Course Conduct Information Package

3. SUBTITLE

Offeror’ s Certificate of Completion

4. AUTHORITY (Data Acquisition Document No.)

DI-PSSS-81522C

5. CONTRACT REFERENCE

SOW PARA 6.0

6. REQUIRING OFFICER

NSWC, CORONA – MS31

7. DD 250 REQ. 9. DIST STATEMENT

REQUIRED

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

LT ASREQ b. COPIES

8. APP CODE C 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION a.

ADDRESSEE

Draft Final

N/A SEE BLK 16 SEE BLK 16 Reg Repr o

16. REMARKS

Blk 9: "DISTRIBUTION STATEMENT C: Distribution authorized to U. S.

Government agencies and their contractors only (Administrative Use). (12 Oct 2017). Other requests for this document shall be referred to the Naval Surface Warfare Center, Corona Division, California, Code MS02."

Blk, 11 – Certificate of completion shall be submitted after the completion of required training courses.

Blk 12 & 13 - Subsequent Transcript of completion shall be submitted after each course completion of nine (9) courses for Oxygen Equipment cleaning and calibration.

Blk 14 - Electronic copy shall be by e-mail in Microsoft Excel format.

NSWC Corona MS31, TPOC Russ Greenhalge Russ.Greenhalge@navy.mil

NSWC Corona

MS31, TPOC

15. TOTAL 1

G. PREPARED BY

//s// Mark Yamashita

H. DATE

10/12/2017

I. APPROVED BY J. DATE

DD Form 1423–1, FEB 2001 Previous editions are obsolete Page __1__ of __1__ Pages

SEE BLK 16

SEE BLK 16

0 0

0 0

//s//T. Sturgeon, NSWC Corona Div MSD CDM 10/12/17

SEE BLK 16