SCNG_CDRL_EXHIBIT_G_SERIES.pdf

For the best experience, open this PDF portfolio in

Acrobat X or Adobe Reader X, or later.

Get Adobe Reader Now!

http://www.adobe.com/go/reader

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The 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 the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. 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 C. CATEGORY:

TDP ________ TM _______ OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP ________ TM _______ OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

16. REMARKS (Continued)

DD FORM 1423-1, FEB 2001 Page of Pages

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package;

TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15.

Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.

DD FORM 1423-1 (BACK), FEB 2001

data_item: G001 title: Accident/Incident Report sub:

auth: DI-SAFT-81563 ref: PWS 1.7.5.3 and 1.7.5.6 req_ofc: AFLCMC/HBDH dd250: LT appcode: N/A dist: D freq: AS REQ asof: N/A firstsub: SEE BLK 16 subsub: SEE BLK 16 addressee1: AFLCMC/HBDH draft1: 0 reg1: 1 repro1: 1 addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 1 remarks: BLK(s) 10, 12 & 13:

Contractor shall deliver an accident/incident report NLT fourteen (14) calendar days after an accident/incident.

BLK 14: Data to be provided on CD ROM or other approved media as authorized by the Government.

The Contractor shall provide a completed copy of the certification required by DFARS 252.227-7017, “Identification and Assertion of Use, Release, or Disclosure Restrictions”. Furthermore, the cover page of any delivered CDRL shall contain the Special License Rights restrictive markings prescribed by DFARS 252.227-7013 and 252.227-7014 or the Government Purpose Rights restricted markings prescribed by DFARS 252.227-2013 and 252.227-7014. The Contractor shall also physically attach a copy of the applicable commercial technical data or computer software delivered as part of this CDRL.

group:

total_price:

prep_name:

line_item:

exhibit: G xtdp: Off xtm: Off othercat: SAFETY system: Scope Command Next Generation ctr_no:

contr:

remarksb:

Page2:

Reset:

2021-10-04T15:27:25-0500

JENSEN.MATTHEW.DAVID.1270355958

prep_date:

app_by:

2021-10-22T10:18:47-0500

FREDERICK.TRACY.LYNN.1097389817

app_date:

Page:

of_pages:

app: Adobe Professional 8.0

DATA ITEM DESCRIPTION

Accident/Incident Report

DI-SAFT-81563, dated 09-Jun-2014, has been reviewed and determined to be valid for use in acquisition.

Reviewer Activities:

Air Force - 27

NOTICE OF

VALIDATION

INCH-POUND

DI-SAFT-81563

NOTICE 2

30-Jun-2020

NOTE: The activities above were interested in this document as of the date of this document. Since organizations and responsibilities can change, you should verify the currency of the information above using the ASSIST Online database at https://assist.dla.mil.

AMSC N/A AREA SAFT

Preparing Activity:

Army - AR

Source: http://assist.dla.mil -- Downloaded: 2021-10-26T15:18Z Check the source to verify that this is the current version before use.

https://assist.dla.mil

DATA ITEM DESCRIPTION

Title: Accidertflncident Report

Number DI-SAFT-8 1563 Approved Date: 2 Jun 98 AMSC Numbec A7315 Limitation:

DT3C Applicable: GIDEP Application:

Office of Primary Respomibility A/AR Applicable Fornw Use/relationship: This reportprovides tAeprocuring agency with immediate notification and information concerning any mrjor acciderrthncident (including fire) resulting in any one or more of the following: causing one or more fatalities, or two or snore disabling injuries; damaging government property exceeding $10,000; atTecting program planning or production schedules;

degrading the safety of the equipment under contract, such that persomel injury or property darnage may be involved, identi@ng a potential hazard requiring corrective action.

a. This Data Item Description contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

b. This Data Item Description replaces DI-H-I 329A.

Requirements:

1. Format. Contractor format is acceptable

2. Content. Report without delay any serious accident or incident (i.e. explosioq fire, flood pressure rupture, major rndfunction) which will adversely affect capabtity to meet contractual obligations. The report shall be made by the fkstest means, giving the following information.

c.

d.

e.

f.

i.

1.

Name, organization, telephone number, and location of the contractor and general manager Name and title of the person(s) reporting Date and time of accidenthcident Location of accidentiiciden~ i.e., building number, fkcility name Brief summary of accidentkscidcnt giving pertinent details”iircludihgtype ‘md qtiti~”of -materiel Cause of accidentliicident Camalties (fatalities, disabling irjuries, exposed to CBR agents) Estimated property damage, if applicable Nature of darnage; effect on production, operations, training or other activity Action taken by contractor Other damage or injuries sustained (public or private) Other pertinent information

Source: http://assist.dla.mil -- Downloaded: 2021-06-10T18:59Z

DI-SAFT-81563

3. Malfunction. If a malfunction of equipment is involved, the following additional information shall be finmished:

a. Equipment nomenclature

b. @@ity illvokd

c. Production lot number(s)

d. Brief teehnieal description of malfunction

I 4. End of DI-SAFT-8 1563

Source: http://assist.dla.mil -- Downloaded: 2021-06-10T18:59Z