1300757872_CDRL.pdf

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 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 this burden, to Department of Defense, Washington Headquarters Service, 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 completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

CLIN 0001

B. EXHIBIT

A

C. CATEGORY

TDP_________ TM___________ OTHER MISC

D. SYSTEM/ITEM

TOWED ARRAY HANDLING EQUIPMENT

FACILITY

E. CONTRACT / PR NO.

PR 1300757872

F. CONTRACTOR

MACTAGGART SCOTT / 7GKK5

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

CERTIFICATION / DATA REPORT

3. SUBTITLE

MERCURY FREE CERTIFICATION

17. PRICE

GROUP I

4. AUTHORITY (Date Acquisition Document No.)

DI-MISC-80678

5. CONTRACT REFERENCE

RIR_QAP_Q03122

6. REQUIRING OFFICE

NUWCDIVNPT CODE 1534

18. ESTIMATED

TOTAL PRICE

N/C

7. DD 250 REQ 9. DIST STATEMNT

REQUIRED

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

14. DISTRIBUTION

LT C

SEE BLOCK 16

SEE BLOCK 16 N/A b. COPIES

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

SUBMISSION

a. ADDRESSEE

Draft Final

N/A N/A N/A Reg Repro

16. REMARKS CODE 1534

BLOCK 9 – SEE BLOCK 16 ADDENDUM R. Hodge 0 1 0

BLOCK 10 – CERTIFICATION REPORT SHALL BE DELIVERED WITH EACH

SHIPMENT

15. TOTAL ______> 0 1 0

G. PREPARED BY:

Ronald Hodge

H. DATE

12 DEC 2018

I. APPROVED BY J. DATE

DD Form 1423-1, Feb 2001 Previous Edition May be Used Page 1 of 1 Pages

BRETZ.ROBERT.JAMES.JR.1040

201714

Digitally signed by BRETZ.ROBERT.JAMES.JR.1040201714 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN, cn=BRETZ.ROBERT.JAMES.JR.1040201714 Date: 2018.12.13 11:42:03 -05'00'

Enclosure (3)

DD FORM 1423, CONTRACT DATA REQUIREMENTS LIST

BLOCK 16 ADDENDUM

PR 1300757872

BLOCK 9: The following information is provided in amplification of the Block 9 Distribution Statement shown on each DD FORM 1423.

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

CDRL A001

Distribution Statement C. Distribution authorized to U.S. Government Agencies and their contractors (Critical Technology) (4/26/2017). Other requests for this document shall be referred to insert (controlling DoD office – NUWCDIVNPT Code 1534

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.