CDRL_A001_CALCert_Dew_Point_Generator_CDMCert_06.10.19.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 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

Dew-Point Generator N64267-19-D-XXXX TBD

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

GROUP

A001 CALIBRATION CERTIFICATE Calibration Certificate

II

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

DI-QCIC-80798B

(See Block 16)

SOW Paragraph: 5.1.3

(See Block 16)

NSWC, Corona Division

TOTAL

PRICE

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

SUBMISSION

14. DISTRIBUTION

LT (See Block 16)

A (See Block 16) (See Block 16) b. COPIES

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

SUBMISSION

a. ADDRESSEE Final

N/A N/A (See Block 16) Draft Reg. Repro

16. REMARKS Daniel M Martinez (MS35) 1

Block 4/5: DI-QCIC-80798B and SOW specification paragraph 5.1.3 shall be used as guidance and are provided for reference. Data points from the actual calibration must be included with this report. Information items in

DI-QCIC-80798B that are not relevant to the procurement do not need to be included in format.

Block 10: Frequency of Calibration Certificate (CDRL A001 subtitle) shall be 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 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.

NSWC Corona Division

Ron Cichy (MS33) 1

NSWC Corona Division

With each calibration performed 1

15. TOTAL 3

G. PREPARED BY

H. DATE I. APPROVED BY J. DATE

D. M. Martinez NSWC, Corona (MS35) 06/10/2019

DD FORM 1423 (CDRL) Supplemental

BLOCK 14 ENTRY COMPLETE ADDRESS

Daniel M Martinez, NSWC, Corona MS35, daniel.m.martinez@navy.mil

MS Department (Attn: Daniel M Martinez, MS35, Building 521)

PO Box 5000

Corona CA 92878-5000

Ron Cichy, NSWC, Corona MS33, ronald.cichy@navy.mil

MS Department (Attn: Ron Cichy MS33, Building 521)

PO Box 5000

Corona CA 92878-5000

Page 2 of 2 Pages mailto:daniel.m.martinez@navy.mil mailto:ronald.cichy@navy.mil