Lip_Seals_-_R1_6-28-16_CDRL.doc

PR # 1300371543

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 440 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 complete form to the Government Issuing Contracting Officer for the Contract/PR NO. listed in Block E.

D. SYSTEM / ITEM

Lip Seals

E. CONTRACT / PR NO.

N66604-16-P-2376

F. CONTRACTOR

Sandem Industries

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

CERTIFICATE OF COMPLIANCE

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-81356A

5. CONTRACT REFERENCE

CLIN 0001

6. REQUIRING OFFICE

NUWCDIVNPT CODE 4014

REQUIRED

LT

b. COPIES

SUBMISSION

NUWC Code 4012

NUWC Code 4013

Blk. 9: See Distribution Statement Addendum

Blks 10-12: The Certificate of Compliance for each shipment shall be submitted to NUWCDIVNPT at time of material delivery. It is requested that it be sent by email to robert.waleyko@navy.mil and william.gajda@navy.mil

15. TOTAL ----------------

1. DATA ITEM NO.

2. TITLE OF DATA ITEM

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE

6. REQUIRING OFFICE

REQUIRED

b. COPIES

8. APP CODE

SUBMISSION

16. REMARKS

Intentionally Left Blank

15. TOTAL --------------->

G. PREPARED BY

Robert M. Waleyko

H. DATE

04/14/16

I. APPROVED BY

Martha Merriwether

J. DATE

6-28-2016

DD Form 1423-2, AUG 96 (EG) Previous Edition May be Used Page ___1_of 1_Page

DD FORM 1423

CONTRACT DATA REQUIREMENTS LIST

PR 1300568481

BLOCK 16 ADDENDUM

BLOCK 9: The following information is specifically included in amplification of the Block 9 Distribution Statement selected:

Distribution Statement paragraphs are in addition to CLASSIFICATION markings of the data.

Distribution Statement D. Applies to CDRL Item No. A001 and A002. Distribution authorized to the DoD and DoD contractors only; Critical Technology. Dated when data generated. Other requests for this document shall be referred to Commander, Naval Undersea Warfare Center Division, Newport, RI, Code 4114.

The following “EXPORT CONTROL WARNING NOTICE” must be used in conjunction with DISTRIBUTION STATEMENTS identified in the above CDRL item:

WARNING – This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U. S. C. Sec. 2751 et seq.) or the Export Administration Act of 1979, as amended, Title 50, U. S. C., App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.