SOLICITATION ATTACHMENT 0002- CONTRACT DATA REQUIREMENTS LIST (CDRLs).pdf

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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 and Communications 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

16. REMARKS (Continued)

DD FORM 1423-1, FEB 2001 Page of Pages

1_DATA_ITEM_NO: A001

2_TITLE_OF_DATA_ITEM: Operations Security (OPSEC) Plan

3_SUBTITLE: Anti-Terrorism Training Certificates

4_AUTHORITY_Data_Acquisit: DI-MGMT-80934C

5_CONTRACT_REFERENCE: 3.4.2.a

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE:

DIST_STATEMENT:

10_FREQUENCY: See Item 16

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: See Item 16

13_DATE_OF_SUBSEQUENT_SUB: See Item 16 addressee1: SAMD draft1:

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16_REMARKS: A001

ANTI-TERRORISM TRAINING

1. BLK 9: The following statement shall be included on the deliverable:

"DISTRIBUTION E. Distribution authorized to DoD Components only to protect information in management reviews, records of contract performance evaluation, or other advisory documents evaluating programs of contractors. Date of determination: 24 May 2023. Other requests for this document shall be referred to CECOM ILSC SAMD, AMEL-LCS-RC, 6580 Reconnaissance Street, Aberdeen Proving Ground, MD, 21005."

2. Employees must complete Level I OPSEC training. New employees must be trained within 60 calendar days after completion of training.

3. Reports of OPSEC Training completed to be submitted as required.

4. All submittals will be in electronic format (e-mail). All submittals shall be delivered to the addressees identified by the contracting officer.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 02/09/2023

Page:

reg38t: 1

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: C

TDP:

TM:

OTHER:

DSYSTEMITEM: Communications and Electronics Equip

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued:

Page2:

of_pages:

Reset:

2022-12-19T13:41:12-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-09T09:27:42-0500

NGO.MONICA.T.1397708027

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 and Communications 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

1_DATA_ITEM_NO: A002

2_TITLE_OF_DATA_ITEM: Operations Security (OPSEC) Plan

3_SUBTITLE: iWATCH Training Report

4_AUTHORITY_Data_Acquisit: DI-MGMT-80934C

5_CONTRACT_REFERENCE: 3.4.2c

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE:

DIST_STATEMENT:

10_FREQUENCY: See Item 16

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: See Item 16

13_DATE_OF_SUBSEQUENT_SUB: See Item 16 addressee1: SAMD draft1:

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16_REMARKS: CDRL A002

iWATCH TRAINING

1. BLK 9: The following statement shall be included on the deliverable:

"DISTRIBUTION E. Distribution authorized to DoD Components only to protect information in management reviews, records of contract performance evaluation, or other advisory documents evaluating programs of contractors. Date of determination: 24 May 2023. Other requests for this document shall be referred to CECOM ILSC SAMD, AMEL-LCS-RC, 6580 Reconnaissance Street, Aberdeen Proving Ground, MD, 21005."

2. Employees must complete Level I OPSEC training. Completed training must be reported to the COR within 60 calendar days after contract award.

3. Reports of OPSEC Training completed to be submitted as required.

4. All submittals will be in electronic format (e-mail). All submittals shall be delivered to the addressees identified by the contracting officer.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 02/09/2023

Page:

reg38t: 1

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: C

TDP:

TM:

OTHER:

DSYSTEMITEM: Communications and Electronics Equip

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued:

Page2:

of_pages:

Reset:

2022-12-19T13:42:14-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-09T09:26:04-0500

NGO.MONICA.T.1397708027

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 and Communications 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

1_DATA_ITEM_NO: A003

2_TITLE_OF_DATA_ITEM: Operations Security (OPSEC) Plan

3_SUBTITLE: OPSEC Plan

4_AUTHORITY_Data_Acquisit: DI-MGMT-80934C

5_CONTRACT_REFERENCE: 3.4.3a

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE:

DIST_STATEMENT:

10_FREQUENCY: See Item 16

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: See Item 16

13_DATE_OF_SUBSEQUENT_SUB: See Item 16 addressee1: SAMD draft1:

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16_REMARKS: CDRL A003

OPERATIONS SECURITY (OPSEC) PLAN

1. BLK 4: Prepare IAW DID

2. BLK 9: The following statement shall be included on the deliverable:

"DISTRIBUTION E. Distribution authorized to DoD Components only to protect information in management reviews, records of contract performance evaluation, or other advisory documents evaluating programs of contractors. Date of determination: 24 May 2023. Other requests for this document shall be referred to CECOM ILSC SAMD, AMEL-LCS-RC, 6580 Reconnaissance Street, Aberdeen Proving Ground, MD, 21005."

3. BLK 12: Submit SOP/Plan NLT 90 days ADAD for review and approval by the Government OPSEC Officer. The Government OPSEC Officer will review and approve within 30 days of submittal of the OPSEC SOP.

4. All submittals will be in electronic format (e-mail). All submittals shall be delivered to the addressees identified by the contracting officer.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 02/09/2023

Page:

reg38t: 1

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: C

TDP:

TM:

OTHER:

DSYSTEMITEM: Communications and Electronics Equip

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued:

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2022-12-19T13:44:16-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-09T09:27:00-0500

NGO.MONICA.T.1397708027

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 and Communications 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

1_DATA_ITEM_NO: A004

2_TITLE_OF_DATA_ITEM: Operations Security (OPSEC) Training

3_SUBTITLE: OPSEC Training

4_AUTHORITY_Data_Acquisit: DI-MGMT-80934C

5_CONTRACT_REFERENCE: 3.4.3b

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE:

DIST_STATEMENT:

10_FREQUENCY: See Item 16

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: See Item 16

13_DATE_OF_SUBSEQUENT_SUB: See Item 16 addressee1: SAMD draft1:

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16_REMARKS: CDRL A004

OPSEC TRAINING

1. BLK 9: The following statement shall be included on the deliverable:

"DISTRIBUTION E. Distribution authorized to DoD Components only to protect information in management reviews, records of contract performance evaluation, or other advisory documents evaluating programs of contractors. Date of determination: 24 May 2023. Other requests for this document shall be referred to CECOM ILSC SAMD, AMEL-LCS-AE, 6580 Reconnaissance Street, Aberdeen Proving Ground, MD, 21005."

2. Employees must complete Level I OPSEC training. New employees must be trained within 30 calendar days of their reporting for duty and annually thereafter.

3. Reports of OPSEC Training completed to be submitted as required.

4. All submittals will be in electronic format (e-mail). All submittals shall be delivered to the addressees identified by the contracting officer.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 02/09/2023

Page:

reg38t: 1

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: C

TDP:

TM:

OTHER:

DSYSTEMITEM: Communications and Electronics Equip

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued:

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2022-12-19T13:45:31-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-09T09:25:22-0500

NGO.MONICA.T.1397708027

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 and Communications 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

1_DATA_ITEM_NO: A005

2_TITLE_OF_DATA_ITEM: Operations Security (OPSEC) - TARP Training

3_SUBTITLE: TARP Training Certificates

4_AUTHORITY_Data_Acquisit: DI-MGMT-80934C

5_CONTRACT_REFERENCE: SOW Paragraph 3.4.4a

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE: A

DIST_STATEMENT: E

10_FREQUENCY: ASRQD

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: SEE BLK 16

13_DATE_OF_SUBSEQUENT_SUB: ASRQD

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reg34:

repro34:

addressee35:

draft35:

reg35:

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addressee36:

draft36:

reg36:

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draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_repro: 0

16_REMARKS: 1. BLK 9: The following statement shall be included on the deliverable:

"DISTRIBUTION E. Distribution authorized to DoD Components only to protect information in management reviews, records of contract performance evaluation, or other advisory documents evaluating programs of contractors. Date of determination: 24 May 2023. Other requests for this document shall be referred to CECOM ILSC SAMD, AMEL-LCS-RC, 6580 Reconnaissance Street, Aberdeen Proving Ground, MD, 21005."

2. BLK 12: Submit an individual’s certificate within 30 calendar days after the employee and/or subcontractor personnel completes training. Multiple certificates may be submitted at one time.

3. BLK 13: The Government OPSEC Officer will review and approve within 30 days of submittal

4. All submittals will be in electronic format (e-mail). All submittals shall be delivered to the addressees identified by the contracting officer.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 02/09/2023

Page:

reg38t: 1

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT:

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: Communications-Electronics Equipment

E_CONTRACTPR_NO:

FCONTRACTOR: PacStar of_pages:

Reset:

2022-12-19T13:39:34-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-09T09:24:31-0500

NGO.MONICA.T.1397708027

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 and Communications 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

1_DATA_ITEM_NO: B001

2_TITLE_OF_DATA_ITEM: Scientific and Technical Report

3_SUBTITLE: Site Survey Plan/Report

4_AUTHORITY_Data_Acquisit: DI-MGMT-80711A

5_CONTRACT_REFERENCE: PWS Para 3.2.1

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE: A

DIST_STATEMENT: E

10_FREQUENCY: As Required

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: See Item 16

13_DATE_OF_SUBSEQUENT_SUB: See Item 16 addressee1: SAMD draft1: 1 reg1: 1 repro1:

addressee2: FMS Customer draft2:

reg2: 1 repro2:

addressee3:

draft3:

reg3:

repro3:

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total_draft: 1 total_repro: 0

16_REMARKS: 1. BLK 9: The following statement shall be included on the deliverable:

Distribution authorized to DoD Components and the FMS Customer. Date of determination: 24 May 2023. Other requests for this document shall be referred to CECOM ILSC SAMD, AMEL-LCS-RC, 6580 Reconnaissance Street, Aberdeen Proving Ground, MD, 21005."

2. BLK 12: First submission of Site Survey Plan/Report due 14 calendar days prior to the site survey reflects plan for surveying the sites.

3. BLK 13: Second submission due 20 calendar days after completion of the site survey includes report of site survey. Government will provide comments to the second submission within 14 calendar days. Final submission due 10 calendar days after receipt of Government comments.

4. Report shall be in contractor format. Delete DID sections 10.1, 10.2, and 11.

5. All submissions shall be delivered in Microsoft Office suite of applications (MS Word, Excel, Power Point) by electronic transmittal (email) to the Contracting Officer’s Representative and accompanied by printed paper copy, if requested. Alternate formats may be allowed subject to Government review and approval.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 2/16/2023

Page:

reg38t: 2

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: C

TDP:

TM:

OTHER:

DSYSTEMITEM: Equipment and Services

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued:

Page2:

of_pages:

Reset:

2023-02-14T10:09:44-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-16T07:34:05-0500

NGO.MONICA.T.1397708027

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 and Communications 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

1_DATA_ITEM_NO: B002

2_TITLE_OF_DATA_ITEM: Test Plan

3_SUBTITLE: System Acceptance Test Plan and Procedures

4_AUTHORITY_Data_Acquisit: DI-NDTI-80566A

5_CONTRACT_REFERENCE: PWS Para 3.2.5

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE: A

DIST_STATEMENT: E

10_FREQUENCY: As Required

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: See Item 16

13_DATE_OF_SUBSEQUENT_SUB: See Item 16 addressee1: SAMD draft1: 1 reg1: 1 repro1:

addressee2: FMS Customer draft2:

reg2: 1 repro2:

addressee3:

draft3:

reg3:

repro3:

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draft4:

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repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 1 total_repro: 0

16_REMARKS: 1. BLK 9: The following statement shall be included on the deliverable:

Distribution authorized to DoD Components and FMS Customer. Date of determination: 24 May 2023. Other requests for this document shall be referred to CECOM ILSC SAMD, AMEL-LCS-RC, 6580 Reconnaissance Street, Aberdeen Proving Ground, MD, 21005."

2. BLK 12: First submission shall be 30 calendar days prior to SAT. Government will provide comments within 14 calendar days.

3. BLK 13: Final submission due 10 calendar days after receipt of Government comments.

4. Report shall be in contractor format. Delete DID sections 4.3.X.e-g.

5. All submissions shall be delivered in Microsoft Office suite of applications (MS Word, Excel, Power Point) by electronic transmittal (email) to the Contracting Officer’s Representative and accompanied by printed paper copy, if requested. Alternate formats may be allowed subject to Government review and approval.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 2/16/2023

Page:

reg38t: 2

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: C

TDP:

TM:

OTHER:

DSYSTEMITEM: Equipment and Services

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued:

Page2:

of_pages:

Reset:

2023-02-14T10:10:09-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-16T07:32:34-0500

NGO.MONICA.T.1397708027

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 and Communications 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

1_DATA_ITEM_NO: B003

2_TITLE_OF_DATA_ITEM: Test/Inspection Report

3_SUBTITLE: System Acceptance Test Report

4_AUTHORITY_Data_Acquisit: DI-NDTI-80809B

5_CONTRACT_REFERENCE: PWS Para 3.2.5

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE: A

DIST_STATEMENT: E

10_FREQUENCY: As Required

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: See Item 16

13_DATE_OF_SUBSEQUENT_SUB: See Item 16 addressee1: SAMD draft1: 1 reg1: 1 repro1:

addressee2: FMS Customer draft2:

reg2: 1 repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

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addressee5:

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addressee38:

draft38:

reg38x:

repro38:

total_draft: 1 total_repro: 0

16_REMARKS: 1. BLK 9: The following statement shall be included on the deliverable:

Distribution authorized to DoD Components and the FMS Customer. Date of determination: 24 May 2023. Other requests for this document shall be referred to CECOM ILSC SAMD, AMEL-LCS-RC, 6580 Reconnaissance Street, Aberdeen Proving Ground, MD, 21005."

2. BLK 12: First submission shall be 30 calendar days after SAT. Government will provide comments within 14 calendar days.

3. BLK 13: Final submission due 10 calendar days after receipt of Government comments.

4. Report shall be in contractor format. Delete DID sections 4.3.X.e-g.

5. All submissions shall be delivered in Microsoft Office suite of applications (MS Word, Excel, Power Point) by electronic transmittal (email) to the Contracting Officer’s Representative and accompanied by printed paper copy, if requested. Alternate formats may be allowed subject to Government review and approval.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 2/16/2023

Page:

reg38t: 2

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: C

TDP:

TM:

OTHER:

DSYSTEMITEM: Equipment and Services

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued:

Page2:

of_pages:

Reset:

2023-02-14T10:10:09-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-16T07:35:03-0500

NGO.MONICA.T.1397708027

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 and Communications 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

1_DATA_ITEM_NO: C001

2_TITLE_OF_DATA_ITEM: Status Reports

3_SUBTITLE: Status Report

4_AUTHORITY_Data_Acquisit: DI-MISC-80368A

5_CONTRACT_REFERENCE: 3.10.1.b

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE: A

DIST_STATEMENT: E

10_FREQUENCY: Monthly

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: See Item 16

13_DATE_OF_SUBSEQUENT_SUB: See Item 16 addressee1: SAMD draft1:

reg1: 1 repro1:

addressee2: FMS Customer draft2:

reg2: 1 repro2:

addressee3:

draft3:

reg3:

repro3:

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total_draft: 0 total_repro: 0

16_REMARKS: 1. BLK 9: The following statement shall be included on the deliverable:

DISTRIBUTION E. Distribution authorized to DoD Components only; Contractor Performance Evaluation; 21 May 14. Other requests for this document shall be referred to CECOM ILSC SAMD, 6565 Surveillance Loop. Bldg 6001, Aberdeen Proving Ground, MD 21005.

2. BLK 12: First report due 30 calendar days after contract award.

3. BLK 13: Subsequent reports shall be submitted monthly thereafter..

4. Report shall be in contractor format.

5. Submission shall be delivered in Microsoft Office suite of applications (MS Word, Excel, Power Point) by electronic transmittal (email) to Contracting Officer’s Representative and accompanied by printed paper copy, if requested. Alternate formats may be allowed subject to Government review and approval.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 02/16/2023

Page:

reg38t: 2

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: C

TDP:

TM:

OTHER:

DSYSTEMITEM: Communications and Electronics Equip

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued:

Page2:

of_pages:

Reset:

2023-02-14T09:08:21-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-16T07:30:18-0500

NGO.MONICA.T.1397708027

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 and Communications 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

1_DATA_ITEM_NO: C002

2_TITLE_OF_DATA_ITEM: Scientific and Technical Reports

3_SUBTITLE: Certificate of Completion

4_AUTHORITY_Data_Acquisit: DI-MISC-80711A

5_CONTRACT_REFERENCE: PWS 3.10.3

6_REQUIRING_OFFICE: SAMD

7_DID_250_REQ: LT

8_APP_CODE:

DIST_STATEMENT:

10_FREQUENCY: As Required

11_AS_OF_DATE:

12_DATE_OF_FIRST_SUBMISSI: See Item 16

13_DATE_OF_SUBSEQUENT_SUB: As Required addressee1: SAMD draft1:

reg1: 1 repro1:

addressee2:

draft2:

reg2:

repro2:

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total_draft: 0 total_repro: 0

16_REMARKS: 1. BLK 4: Delete 10.2 of the DID and prepare IAW this CDRL and the PWS

2. BLK 12: Submit each certificate of completion along with each DD 250 as each CDRL requirement is completed

3. BLK 13: SUBMIT FINAL

The contractor shall provide a completed Certificate of Completion with each DD Form 250 for ALL CDRLs included in this PWS.

The information shall present data as described below:

As a minimum, the Contractor shall provide the following (see attached template in Appendix):

1) Contractor Information. Contract information, to include but not limited to:

a. Contract number

b. Delivery Order Number

c. Contract CLIN

d. FMS Case designator

e. Period/service being invoiced

f. Contractor Point of contact for certificate of completion to include, printed name, position/title/rank, phone number, email and signature certifying completion.

2) Identifying the person’s information that can verify that the services have been completed to include but not limited to:

Country/customer/US Government Personnel, point of contact for certificate of completion to include, printed name, position/title/rank, phone number, email address and signature verifying completion.

4. All submittals shall be by electronic transmittal (e-mail) and shall include DD Form 250. All submittals shall be delivered to the addressees identified by the contracting officer.

17_PRICE_GROUP:

ESTIMATED_TOTAL_PRICE:

G_PREPARED_BY:

H_DATE:

1_APPROVED_BY:

J_DATE: 2/16/2023

Page:

reg38t: 1

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: C

TDP:

TM:

OTHER:

DSYSTEMITEM: Communications and Electronics Equip

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued:

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of_pages:

Reset:

2023-02-14T09:09:19-0500

HOELTERLING.ALLISON.ANN.1550227270

2023-02-16T07:31:26-0500

NGO.MONICA.T.1397708027