I.H. PR1301117078 CDRL A001-A002 Flat_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.

B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER MISC

D. SYSTEM/ITEM

9070 HYDRAULIC MOTOR

E. CONTRACT / PR NO.

1301117078

F. CONTRACTOR

REIDVILLE

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

CERTIFICATE OF COMPLIANCE

3. SUBTITLE

CERTIFICATE OF COMPLIANCE (COC)

17. PRICE

GROUP 1

4. AUTHORITY (Date Acquisition Document No.)

DI-MISC-81356A

5. CONTRACT REFERENCE

RIR_QAP_W04416

6. REQUIRING OFFICE

NPT-15-NUWC

18. EST MATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMNT

REQUIRED 10. FREQUENCY

12. DATE OF FIRST SUBMISSION

14. DISTRIBUTION

LT

SEE BLOCK 16

1 TIME SEE BLOCK 16 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 NPT-15-NUWC 0 1 0

Block 9: DISTRIBUTION STATEMENT D: DISTRIBUTION AUTHORIZED TO THE

DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY; CRITICAL

TECHNOLOGY. OTHER REQUEST FOR THIS DOCUMENT SHALL BE REFERRED

TO NAVAL UNDERSEA WAREFARE CENTER, NEWPORT DIVISION

Block 12: Submit certification of compliance data sheet upon completion of each delivered batch.

15. TOTAL > 0 1 0

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

DD Form 1423-1, Feb 2001 Previous Edition May be Used Page 1 of 2 Pages

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.

B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER MISC

D. SYSTEM/ITEM

9070 HYDRAULIC MOTOR

E. CONTRACT / PR NO.

1301117078

F. CONTRACTOR

REIDVILLE

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

CERTIFICATE OF COMPLIANCE

3. SUBTITLE

MERCURY FREE CERTIFICATION

17. PRICE

GROUP 1

4. AUTHORITY (Date Acquisition Document No.)

DI-MISC-81356A

5. CONTRACT REFERENCE

RIR_QAP_W04416

6. REQUIRING OFFICE

NPT-15-NUWC

18. EST MATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMNT

REQUIRED 10. FREQUENCY

12. DATE OF FIRST SUBMISSION

14. DISTRIBUTION

LT

SEE BLOCK 16

1 TIME SEE BLOCK 16 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 NPT-15-NUWC 0 1 0

Block 9: DISTRIBUTION STATEMENT D: DISTRIBUTION AUTHORIZED TO THE

DEPARTMENT OF DEFENSE AND U.S. DOD CONTRACTORS ONLY; CRITICAL

TECHNOLOGY. OTHER REQUEST FOR THIS DOCUMENT SHALL BE REFERRED

TO NAVAL UNDERSEA WAREFARE CENTER, NEWPORT DIVISION

Block 12: Submit certification of compliance data sheet upon completion of each delivered batch.

15. TOTAL > 0 1 0

G. PREPARED BY

HODGE, RONALD F.

H. DATE

10/04/2023

I. APPROVED BY

J. DATE

DD Form 1423-1, Feb 2001 Previous Edition May be Used Page 2 of 2 Pages

10/4/23LAFLEUR.VERONICA.

AIMEE M.1008802714

Digitally signed by

LAFLEUR.VERONICA.AIMEE M.1008802714

Date 2023.10.04 08 03 03 -04 00'

Enclosure (3)

DD FORM 1423, CONTRACT DATA REQUIREMENTS LIST

BLOCK 16 ADDENDUM

PR 1301117078

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.

CDRLs A001 through A002

Distribution Statement D . 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.