N6660422Q0195_Exhibit A - CDRLs Redacted.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.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP________ TM___________ OTHER: NDIT

D. SYSTEM/ITEM

Protective Nose Cover Material Certification

E. CONTRACT / PR NO.

PR# 1300978960

F. CONTRACTOR

Precision Urethane & Machine, Inc.

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM:

Test/Inspection Report

3. SUBTITLE

First Article Test Report

17. PRICE GROUP

4. AUTHORITY (Date Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW Para# N/A

6. REQUIRING OFFICE

NUWCDIVNPT, Code 8524

18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ

LT

9. DIST STATEMNT

REQUIRED

10. FREQUENCY

OTIME

12. DATE OF FIRST

SUBMISSION

See Block 16*

14. DISTRIBUTION

See Block 16*

D* b. COPIES

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

SUBMISSION

a. ADDRESSEE Draft Final

N/A See Block 16* N/A See Block 16* Reg Repro

16. REMARKS PI 0 1 0

Block 9: See BLOCK 16 ADDENDUM

Block 10: One (1) submissions is anticipated.

Block 12 & 13: Contractor shall deliver a first article material certification for the Protective Nose Cover in accordance with modified Part # 7054077_A_ALL_redline provided as GFI, for the Guidance and Control Section (G&C) Nose Array of the MK 48 Torpedo within 5 days of the delivery of the first article.

Block 14: Media Requirements: The report shall be delivered electronically in Microsoft 2016 format with email notification to the following address:

15. TOTAL

0 1 0

G. PREPARED BY:

H. DATE

08 FEB 2022

I. APPROVED BY

J. DATE

DD Form 1423-1, Feb 2001 Previous Edition May be Used Page __1__ of __1 Pages