The file's text, extracted by GovTribe without its formatting.
Attachment 1
CONTRACT DATA REQUIREMENTS LIST
(2 Data Items) 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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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 |
| HM&E Modernization |
| N65540-13-R-0052 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
TOTAL PRICE
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| Weekly |
| See block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
Electronic submittal of weekly status reports providing the accomplishment of industrial production work, pre-fabrication, etc. of the previous week. Report should also provide planned upcoming work, issues, lessons learned, etc. and provided to applicable SME.
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A002 |
| Financial Reports |
| N/A |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| Monthly |
| See Block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See Block 16
| Electronic submittal of financial reports shall be provided to applicable SME and COR on a monthly basis. Increased frequency may be requested dependent on job criticality. Reports (at a minimum) shall reflect awarded ceiling, funded ceiling, expenditures, commitments and balance. |
| COR |
| 0 |
| 1 |
| 0 |
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| Kevin Driscoll, Code 917 |
| 08/14/2013 |
DD FORM 1423-2, AUG 96 (EG)
PREVIOUS EDITION MAY BE USED
Page 1 of 8 Page(s)
CONTRACT DATA REQUIREMENTS LIST
(2 Data Items) 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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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 |
| H&ME Modernization |
| N65540-13-R-0052 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A003 |
| Plan of Attack & Milestones (POAM) |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| Once |
| See block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
Electronic submittal of POA&M that breaks out the pre-fabrication, installation, testing and completion of assigned installs and tasks. POAMs are to be submitted to the applicable SME based on the requirements of each task order.
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A004 |
| Quality Assurance (QA) Workbook |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
LT
b. COPIES
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
For first time accomplishment of alterations/SCDs, the QA workbook must be submitted to SME at least 30 days prior to start of install for review. The QA workbook must follow the NAVSSES Section layout.
For subsequent installs, the QA workbook does not need to be submitted.
For all installs, the QA workbook must be maintained onboard the ship and available to OSIC and NSA review.
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| Kevin Driscoll, Code 917 |
| 08/14/2013 |
Page 2 of 8 Page(s)
CONTRACT DATA REQUIREMENTS LIST
(2 Data Items) 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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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 |
| H&ME Modernization |
| N65540-13-R-0052 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A005 |
| Personnel Qualifications / Certifications |
Training List
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| Once |
| See block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
The list of personnel that will be onboard the ship performing the production/testing must be provided in the QA Workbook. Provide company letterhead matrix of personnel qualifications and certifications such as welders, fire watch, inspectors, competent persons, etc.; as required to perform the installation/testing.
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A006 |
| In-Process Control Procedures (IPCPs) |
| N/A |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| Once |
| See Block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See Block 16
Provide clear, concise, and technically correct instructions to complete the task in a sequential manner while conforming to the NAVSEA Standard Items (NSI) and technical specifications. (I), (V) and (G) >test and inspection points shall be annotated at appropriate steps. (I) and (G) points shall reference applicable NSI or >governing specification, and records shall be retained in QA Workbook Section 7.
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| Kevin Driscoll, Code 917 |
| 08/14/2013 |
DD FORM 1423-2, AUG 96 (EG)
PREVIOUS EDITION MAY BE USED
Page 3 of 8 Page(s)
CONTRACT DATA REQUIREMENTS LIST
(2 Data Items) 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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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 |
| H&ME Modernization |
| N65540-13-R-0052 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A007 |
| Production Status Reports |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| Weekly |
| See block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
Weekly submittal of status reports detailing the production work or testing that was accomplished to date. This report shall also provide a documentation of all deckplate production and design issues.
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A008 |
| Red-lined Ship Install Drawings (SIDs) |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
b. COPIES
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
A set of red-lined SIDs shall be provided to the ship and to the OSIC prior to job completion. Red-lined package shall include all design changes and LARs.
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| Kevin Driscoll, Code 917 |
| 08/14/2013 |
Page 4 of 8 Page(s)
CONTRACT DATA REQUIREMENTS LIST
(2 Data Items) 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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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 |
| H&ME Modernization |
| N65540-13-R-0052 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A009 |
| Lessons Learned Reports |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| Once |
| See block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
Upon completion of each install, provide a “Lessons Learned” report that details the production, design, testing, etc. that was encountered during the install. This report will be valuable for the SME to recommend changes to the sponsor for future installs on the same ship class or other classes.
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
b. COPIES
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
As tasked by the SME, provide meeting minutes that capture the technical discussion, action items, and estimated action delivery dates.
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| Kevin Driscoll, Code 917 |
| 08/14/2013 |
Page 5 of 8 Page(s)
CONTRACT DATA REQUIREMENTS LIST
(2 Data Items) 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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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 |
| H&ME Modernization |
| N65540-13-R-0052 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A011 |
| Warehouse / Staging Inventory Report |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| As required |
| See block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
Report on all quantity of equipment, material, and tools that were procured under the task order that are being housed at the various contractor facilities for future shipboard installs.
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A012 |
| Hazardous Material Reports |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
b. COPIES
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
A report on all hazardous material, hazardous waste and disposal invoices and data that were required during the installations under the task orders.
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| Kevin Driscoll, Code 917 |
| 08/14/2013 |
Page 6 of 8 Page(s)
CONTRACT DATA REQUIREMENTS LIST
(2 Data Items) 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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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 |
| H&ME Modernization |
| N65540-13-R-0052 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A013 |
| Pre-installation Site Survey |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| As required |
| See block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
Provide a report that provides findings and S/F contacted during each ship check/ship visit.
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A014 |
| Test & Inspection Reports |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
b. COPIES
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
This is Section 7 of the QA Workbook that provides all completed Test and Inspection Reports for each install. This includes all forms that are used to document the tests >and inspections performed in Section 6 (IPCPs).
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| Kevin Driscoll, Code 917 |
| 08/14/2013 |
Page 7 of 8 Page(s)
CONTRACT DATA REQUIREMENTS LIST
(2 Data Items) 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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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 |
| H&ME Modernization |
| N65540-13-R-0052 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| As required |
| See block 16 |
A
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
Provide a technical report that provides calculations, analysis, findings, etc. as delineated by the SME.
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A016 |
| Databases or other Electronic Documents |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
| SOW Paragraph 6.1 |
| NSWCCD-SSES 917 |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10 FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
b. COPIES
8. APP CODE
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
N/A
See block 16
Provide all Microsoft Excel, Word, Power Point, Project documents or other electronic documents as required and tasked by the SME.
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| Kevin Driscoll, Code 917 |
| 08/14/2013 |
Page 8 of 8 Page(s)