CDRL_A001-_Raw_Materials_Supplier_List.pdf

Form QM1006 - CSI@LKE 17, 19000

CONTRACT DATA REQUIREMENTS LIST 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 Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the

Office 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 Office for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

EXHIBIT

A1

C. CATEGORY:

TDP_______ TM_______ X OTHER

D. SYSTEM ITEM

ALRE and SE Components

E. CONTRACT/PR NO.

N68335-19-R-0030

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Raw Materials Suppliers List

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

SOW Par 3.4.4

6. REQUIRING OFFICE

4.8.8.4

7. DD 250 REQ

LT

9. DIST STATEMENT

As Required

10. FREQUENCY

ONE TIME

12. DATE OF FIRST

SUBMISSION

30 D.A.C.

14. DISTRIBUTION

a. ADDRESSEE b. COPIES

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

N/A

Draft Final

Reg Repr

16. Block 4: Contractor format is acceptable.

Block 4: List all raw material suppliers to include company name, address, and

CAGE if applicable.

CODE 4.8.8.6 0 1

CODE 4.8.8.4 0 1

15. TOTAL 1 2

G. PREPARED BY

K. Borrero

H. DATE

16 OCT 2018

I. APPROVED BY

J. DATE