CDRL A002.pdf

DD FORM 1423-1, JUN 09 PREVIOUS EDITIONS ARE OBSOLETE PAGE (1) OF (1) 10 June 2009 CONTRACT DATA REQUIREMENTS LIST (1 Data Item) FORM APPRVD 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 HWY, Suite 1204, Arlington VA, 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-01880, 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 ( XX )

D. System/Item MQ-9 - Payload I&R Jack Assembly

E. Contract/PR No.

TBD

F. Contractor

TBD

1. Data Item No.

A002

2. Title of Data Item

Test/Inspection Report

3. Subtitle

Proof Load Certificates & Non-Destructive Inspection Certificates

4. Authority (Data ID No.)

DI-NDTI-80809B See Block 16

5. Contract Reference SOW Para. 3.2

6. Requiring Office

NAVAIR LKE, UAS SE BR, BL24100

7. DD 250 REQ

LT

9. Dist. Statement Req.

D

10. Frequency

AS REQ

See Block 16

12. Date of first submission

See Block 16

14. Distribution

8. APPCODE

N/A

11. As of Date N/A

13. Date of Subsequent Submission See Block 16

Address Dr aft

Re g

Re pr

16. Remarks shivam.suleria.civ@us.navy.mi l

Block 4: Contractor Format is acceptable. Use DI-NDTI-80809B for guidance. jeffery.a.glines.civ@us.navy.mi l

Block 9: Use Distribution Statement D. Distribution authorized to DoD and DoD Contractors only, (30 January 2007) other U.S. requests shall be referred to Commanding Officer, Naval Air Warfare Center, Aircraft Division, Lakehurst, NJ 08733-5000

Block 12: A copy of the Proof Load Certificate and NDI Certificate shall be shipped with each item. They shall be secured to the item using a plastic bag/pouch/envelope or a temporary fastening device such as a zip tie.

Block 13: An electronic copy of each Proof Load and NDI Certificate shall be submitted within 15 days of actual hardware delivery for each production unit.

Block 14: Delivery Media: Distribution of data shall conform to Electronic Media Compatible with MS Word or MS-Excel or PDF. Proof Load & Non-Destructive Inspection Certificates shall be delivered to:

Shivan Suleria at shivam.suleria.civ@us.navy.mil Jeffery Glines at jeffery.a.glines.civ@us.navy.mil

TOTAL 4

G. Prepared By

Jennifer M. Etri

H. Date

I. Approved By

Adam M. Smiga

J. Date

17. Price Group 18. Estimated Total Price: