CDRL_A001_CertOfCompliance_PTC_CDMCert_02.28.2018.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 MISC

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

Pressure Test Chamber N64267-18-D-XXXX TBD

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

A001 Certificate of Compliance Certificate of Compliance

II

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

DI-MISC-81356A

(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 (See Block 16)

LT 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) Dra ft

Re g.

Re pro

16. REMARKS Daniel M Martinez (MS35) 1 Block 4/5: DI-MISC-81356A shall be used as guidance and are provided for reference.

SOW specification paragraph 5.1.3 is mandatory to this requirement and is provided for guidance. Information items in DI-MISC-81356A that are not relevant to the procured unit do not need to be included in format.

Block 10/12/13: Submissions of Certificate of Compliance (CDRL A001 subtitle) shall be provided with each Pressure Test Chamber installed.

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.

NSWC Corona Division Shayson Edwards (MS33) 1 NSWC Corona Division With each unit installed 1

15. TOTAL 3

G. PREPARED BY

H. DATE I. APPROVED BY J. DATE

D. M. Martinez NSWC, Corona (MS35) 02/20/2018

K. Bergland, NSWC Corona, MSD CDM 02/28/2018

Page 1 of 2 Pages

DD FORM 1423 (CDRL) Supplemental

BLOCK 14 ENTRY COMPLETE ADDRESS

Daniel M Martinez, NSWC, Corona MS35, daniel.m.martinez@navy.mil NSWC Corona Division MS Department (Attn: Daniel M Martinez, MS35, Building 521) PO Box 5000 Corona CA 92878-5000

Shayson Edwards, NSWC, Corona MS33, shayson.edwards.ctr@navy.mil NSWC Corona Division MS Department (Attn: Shayson Edwards, MS33, Building 521) PO Box 5000 Corona CA 92878-5000

Page 2 of 2 Pages mailto:daniel.m.martinez@navy.mil mailto:shayson.edwards.ctr@navy.mil