N6572623Q0001_CDRL_A001.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

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, Executive Services, Directorate (0704-0188). 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

A

C. CATEGORY:

TDP TM OTHER

Maintenance/Repair Report

D. SYSTEM/ITEM

Velocity Access System

E. CONTRACT/PR NO.

1300902825

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Detailed Service Report

3. SUBTITLE

Service Report for Velocity System

17. PRICE GROUP

4. AUTHORITY (Data Acquisition Doc. No.)

DI-MGMT-80995

5. CONTRACT REFERENCE

SEE BLK 16 REMARKS

6. REQUIRING OFFICE

NUWCDIVKPT

7. DD 250 REQ

DD

9. DIST STATEMENT

REQUIRED

NONE

10. FREQUENCY

One Time

12. DATE OF FIRST SUBMSSN

SEE BLK 16

14. DISTRIBUTION

SEE BLOCK 16

18. ESTIMATED

TOTAL PRICE

8. APP CODE SEE BLK 16 11. AS OF DATE 13. DATE OF SUBSEQ SUBMSSN b. COPIES

N/A N/A N/A a. ADDRESSEE Final

16. REMARKS Draft Reg Repro Technical POC 1 1

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

DD Form 1423-1, FEB 2001 Previous editions are obsolete. Page 1 of 1 Pages

BLOCK 5: IAW SOW.

BLKS 10, 12: Detailed service report is to be delivered no later than 10 business days after service visit to Keyport.

BLOCK 14: Deliverable format:

Text Document: Adobe PDF (.PDF, searchable) or Microsoft Word (.DOC) Presentation: Adobe PDF (.PDF, searchable) or Microsoft PowerPoint (.PPT) Spreadsheet: Microsoft Excel (.XLS)

Distribution addresses and electronic mailing addresses are provided below:

1) NUWC Division Keyport, Ian Williamson, Tech POC, ian.williamson@navy.mil

Mailing address:

NAVAL UNDERSEA WARFARE CENTER

DIVISION KEYPORT

610 DOWELL STREET

KEYPORT WA 98345-7610

Block 14. DISTRIBUTION

Distibution addressees and electronic mailing addresses are provided below.

Block 14 Entry Addressee E-mail Address

Distribution addressees and mailing addresses are provided below.

Block 14 Entry Addressee Attention

Commander

Naval Undersea Warfare Center

Division Keyport

610 Dowell Street

Keyport, WA 98345-7610