(9)_PR_1300777584_CDRLs.doc

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.

1300777584

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

TEST/INSPECTION REPORT

3. SUBTITLE

TEST/INSPECTION REPORT

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW Para 4.1

6. REQUIRING OFFICE

NUWCDIVNPT CODE 4014

REQUIRED

LT

b. COPIES

SUBMISSION

Blk C (Other): MISC

Blk. 4: Contractor format is acceptable.

BLk. 9: See Block 16 Distribution Statement Addendum Blks 10-12: The Test Report shall be submitted to NUWCDIVNPT and included with the delivery of the two First Article Lip Seals.

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

CERTIFICATE OF COMPLIANCE

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-81356A

5. CONTRACT REFERENCE

SOW Para 4.1

6. REQUIRING OFFICE

NUWCDIVNPT CODE 4014

REQUIRED

LT

b. COPIES

8. APP CODE

SUBMISSION

Blk C (Other): MISC

Blk. 4: Contractor format is acceptable.

BLk. 9: See Block 16 Distribution Statement Addendum Blks 10-12: The Certificate of Compliance for the Lip Seals shall be submitted to NUWCDIVNPT and included with the delivery of the Lip Seals. One Certificate of Compliance with the delivery of the two First Article Lip Seals, and one with the delivery of the complete lot of 1000 Lip Seals. This shall include material validation / certification documentation for all parts used in the buildup of the Lip Seals. This shall include material certification data IAW drawing JCM-1664 note 5. Note 7 requirement for the use of Henkel Loctite Super Glue can be substituted with PACER RX-500 CA.

G. PREPARED BY

Robert M. Waleyko

H. DATE

3/13/2019

I. APPROVED BY

J. DATE

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

PR # 1300777584

DD FORM 1423

CONTRACT DATA REQUIREMENTS LIST

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 Naval Undersea Warfare Center Division, Newport, RI, Code 4014.

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.