Att__1_1300635663_CDRLs_20171127_Final.pdf

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 A C. CATEGORY

0026 TDP_______ TM ______________________ OTHER _________See Blk 16_____________________

D. SYSTEM / ITEM

Turbine Pump Shaft

E. CONTRACT / PR NO.

PR# 1300635663

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Request for Variance (RFV)

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-SESS-80640D

5. CONTRACT REFERENCE

SOW Paragraph 4.0, 4.4.2 and 4.2.3.1

6. REQUIRING OFFICE

NUWCDIVNPT Code 4023

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

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

See Block 16 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

A (See Block 16 Addendum)

N/A See Block 16 Reg Repro

16. REMARKS

Block C-Category Other-SESS

Code 4023 (Vladimir Storozinsky - TPOC)

1 1 0

Block 7: Deliver draft on LT; deliver final on DD NSWCPD 1 1 0

Block 9: See attached Block 16 addendum

Block 10, 12, 13: Contractor shall deliver RFV within 5 days after identification of configuration item issue. The Government with review and comment within 10 days after receipt of RFV. Upon government approval of RFV, the contractor shall incorporate change within 5 days after receipt of Government comments and proceed with task. One delivery is estimated.

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

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

A002

2. TITLE OF DATA ITEM

Technical Report – Study/Services

3. SUBTITLE

See Block 16

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-80508B

5. CONTRACT REFERENCE

SOW Paragraph 4.1.1 and 4.1.3

6. REQUIRING OFFICE

NUWCDIVNPT Code 4024

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

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

See Block 16 See Block 16 See Block 16 b. COPIES

A (See Block 16 Addendum)

N/A See Block 16 Reg Repro

16. REMARKS

Code 4023 (Vladimir Storozinsky - TPOC)

1 1 0

Block C – Category OTHER – SESS Block 3: SOW 4.1.1 Coating Procedures SOW 4.1.3 Dye Penetrant Inspection Procedures Block 9: See attached Block 16 addendum Block 10, 12, 13: Contractor shall deliver procedures within 10 days after identification of configuration item issue. The government will review and comment within 15 days after receipt. Upon government approval, the contractor shall incorporate any change and proceed with production. At least one delivery is estimated.

Block 14: Reg copy to be delivered on CD-ROM and hardcopy

NSWCPD 1 1 0

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

G. PREPARED BY

Vladimir Storozinsky

H. DATE

04/10/17

I. APPROVED BY

Martha Merriwether

J. DATE

1-2-2018

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

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

0026 TDP_______ TM ______________________ OTHER ________SEE BLK 16_

D. SYSTEM / ITEM

Turbine Pump Shaft

E. CONTRACT / PR NO.

A003

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

See Block 16

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW Paragraph 4.1.2 and 4.1.3

6. REQUIRING OFFICE

NUWCDIVNPT Code 4023

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

Block C-Category Other- NDTI

Code 4023 (Vladimir Storozinsky - TPOC)

0 1 0

Block 3: SOW 4.1.3 Dimensional Inspection Report SOW 4.1.3 Dye Penetrant Inspection Report

NSWCPD 0 1 0

SOW 4.1.2 Coating Sample Inspection Report SOW 4.1.3 Coating Inspection Report

Block 4: Contractor format acceptable

Block 9: See Distribution Statement Addendum

Block 10-12: The Contractor shall deliver T/I Reports for each Test within 10 days prior to the delivery of each hardware deliverable

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

1. DATA ITEM NO.

A004

2. TITLE OF DATA ITEM

Certificate of Compliance

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-81356A

5. CONTRACT REFERENCE

SOW Paragraph 4.1.2, 4.1.5 and 4.2.4

6. REQUIRING OFFICE

NUWCDIVNPT Code 4023

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

Block C-Category-other MISC

Code 4023 (Vladimir Storozinsky - TPOC)

0 1 0

Block 9: See Block 16 Addendum NSWCPD 0 1 0

Block 10, 12: The Contractor shall deliver a Certificate of Compliance for all hardware deliverables.

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

Vladimir Storozinsky

H. DATE

04/10/17

I. APPROVED BY

Martha Merriwether

J. DATE

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

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

0026 TDP_______ TM ______________________ OTHER _______See MISC______________________

D. SYSTEM / ITEM

Turbine Pump Shaft

E. CONTRACT / PR NO.

A005

2. TITLE OF DATA ITEM

Technical Report – Study/Services

3. SUBTITLE

SEE BLOCK 16

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-80508B

5. CONTRACT REFERENCE

SOW Paragraph 4.2.3, 4.2.4

6. REQUIRING OFFICE

NUWCDIVNPT Code 4023

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

A (See Block 16 Addendum)

N/A N/A Reg Repro

16. REMARKS

Code 4023 (Vladimir Storozinsky - TPOC)

1* 1 0

Block 9: See Block 16 Addendum Block 3: SOW 4.2.3 Condition Found Report. Draft and final Block 10-12: Contractor shall deliver Condition Found Report within 5 days after identification of incident/need. The Government will review, comment and provide disposition within 5 days after receipt of report. At least one delivery is estimated.

Block 3 – SOW 4.2.4 Balancing Report – no draft for Government review needed. Submit within 10 days after each hardware deliverable.

Block 14 draft only for Condition Found Report

NSWCPD 1 * 1 0

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

A006

2. TITLE OF DATA ITEM

Certification/Data Report

3. SUBTITLE

See Block 16

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-80678

5. CONTRACT REFERENCE

SOW Paragraph 4.1. and 4.2

6. REQUIRING OFFICE

NUWCDIVNPT Code 4023

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

Block C-Category-other MISC

Code 4023 (Vladimir Storozinsky - TPOC)

1 0

Block 3: Mercury-Free Certification Report Balancing Report

NSWCPD 1 0

Block 9: See Block 16 Addendum

Block 10, 12: The Contractor shall deliver a Certification Report for each hardware deliverable within 10 days after receipt of hardware.

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

Vladimir Storozinsky

H. DATE

04/10/17

I. APPROVED BY

Martha Merriwether

J. DATE

PR 1300635663

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.

CDRLs: A001-A006

BLOCK 9:

Distribution Statement D: Distribution authorized to DoD and DoD Contractors only; Critical Technology; Other requests for this document shall be referred to NUWCDIVNPT, Vladimir Storozinsky, Code 4023, 401-832-4778.

The following "EXPORT CONTROL WARNING NOTICE" must be used in conjunction with DISTRIBUTION STATEMENTS identified in all CDRL Items.

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.