Attachment_1_CDRLs.pdf

Enclosure (3)

CONTRACT DATA REQUIREMENTS LIST

(2 DATA ITEMS)

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.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY

0001 A TDP_______ TM ______________________ OTHER ______See Block 16____________________

D. SYSTEM / ITEM

VLC Land Pads

E. CONTRACT / PR NO.

PR 1300618532

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Status Report

3. SUBTITLE

Status report

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80368A

5. CONTRACT REFERENCE

SOW Paragraph 4.1.1.a & 4.2.1.a

6. REQUIRING OFFICE

NUWCDIVNPT Code 4022

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT See Block 16 See Block 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE

Draft

Final

N/A (See Block 16 ) 0 See Block 16 Reg Repro

16. REMARKS Code 4022 (Kotas) 0 1 0

Block 4: Contractor format acceptable Code 4022 (Cullinane) 0 1 0

Block 9: See Block 16 Addendum

Block 10-11, 12,13: The Contractor shall deliver a monthly status report 5 days after end of month with subsequent submissions monthly thereafter

Block 14: Reg copy to be delivered via email or electronic submission

Block C – Category – Other MGMT

15. TOTAL ----------------> 0 2 0

A002

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

Inspection Report

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW Paragraph 4.1.1.b & 4.2.1.b

6. REQUIRING OFFICE

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT See Block 16 See Block 16 b. COPIES

N/A (See Block 16 ) N/A N/A

16. REMARKS Code 4022 (Kotas) 1 0

Code 4022 (Cullinane) 1 0

Block C – Category Other - NDTI

Block 4: Contractor format acceptable

Block 9: See Distribution Statement Addendum

Block 10-12: The Contractor shall deliver Inspection Reports with each hardware delivery of land pads.

15. TOTAL ---------------> 2 2 0

G. PREPARED BY

Vivian Hilton

H. DATE

01/12/17

I. APPROVED BY

Martha Merriwether

J. DATE

3-3-2017

DD Form 1423-2, AUG 96 EG Previous editions may be used

(2 DATA ITEMS)

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.

A. CONTRACT LINE ITEM NO. B. EXHIBIT A C. CATEGORY

0001 TDP_______ TM ______________________ OTHER _______MISC_____________________

D. SYSTEM / ITEM

VLC Land Pads

E. CONTRACT / PR NO.

PR 1300618532

F. CONTRACTOR

A003

2. TITLE OF DATA ITEM

Technical Report – Study/Services

3. SUBTITLE

OQE Report

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-80508B

5. CONTRACT REFERENCE

SOW Paragraph 4.1.1.c & 4.2.1.c

6. REQUIRING OFFICE

NUWCDIVNPT Code 4022

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT See Block 16 See Block 16 b. COPIES

N/A (See Block 16 Addendum)

N/A N/A Reg Repro

16. REMARKS Code 4022 (Kotas) 1 0

Code 4022 (Cullinane) 0 1 0

Block 4: Contractor format acceptable

Block 9: See Distribution Statement Addendum

Block 10-12: The Contractor shall deliver OQE Reports 15 days prior to each

Hardware delivery of land pads.

15. TOTAL ----------------> 1 2 0

A004

2. TITLE OF DATA ITEM

Certificate of Compliance

3. SUBTITLE

Certificate of Compliance

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-81356A

5. CONTRACT REFERENCE

SOW Paragraph 4.1.1.d & 4.2.1.d

6. REQUIRING OFFICE

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT See Block 16 See Block 16 b. COPIES

N/A (See Block 16 Addendum)

N/A N/A

16. REMARKS Code 4022 (Kotas) 0 1 0

Block 4: Contractor format acceptable Code 4022 (Cullinane) 0 1 0

Block 9: See Distribution Statement Addendum

Block 10-12: The Contractor shall deliver a Certificate of Compliance with all hardware deliveries of .

Land Pads

15. TOTAL ---------------> 0 2 0

G. PREPARED BY

Vivian Hilton

H. DATE

01/12/17

I. APPROVED BY

Martha Merriwether

J. DATE

3/3/2017

DD Form 1423-2, AUG 96 eg Previous editions may be used

ERP PR# 1300618532

DD FORM 1423

BLOCK 16 ADDENDUM

Block 9: the following information is amplification of the Block 9

Distribution Statement Selected:

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

Distribution statement D: Applies to CDRL item Nos. A001-A004.

Distribution authorized to the DoD and DoD contractors only; CRITICAL

TECHNOLOGY (date data generated). Other requests for this document shall be referred to NUWC Division, Newport (Michael Cullinane, Code 4022).

The following “EXPORT CONTROL WARNING NOTICE” must be used in conjunction with DISTRIBUTION STATEMENT identified in the above CDRL items.

Warning – This document contains technical data whose export is restricted by the Arms Export Control

Act (Title 22, U.S.C. Sec 27521 et seq.) or the Export

Administration Act of 1979, as amended, title 50, U.S.C., App 2401 et seq. Violation of these exports laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.