9193-3G50_CDRLS.pdf

0006AA A

A001

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) 0MB No. 0704-0188 Public reporting burden for !his colledlon or lnfoonatlon la estimated to average 110 hounl per 1111ponse, Including the time ror l'IIWIWlng lnsUuctlons,, searching exlltlng data sources, gathel'lng and malnlalnlng !he data needed, and completing and l'IIVIIIWing the collection or Information. Send comments regarding 1h11 burden el11rnate or any other aped or this collecllon or lnronnatlon, Including suggestions for l'llducing the bunlen, to Department or Defense, Walhlng1on Headquarteni Services, Directorate for lnfarmatlon Operations and Reports (0704-0188), 1215 Jeffenon Davia Highway, SuKe 1204, Arlington VA 22202-4302, Please DO NOT RET\JRN vour form to either of these addrua. Send comoleted form to the Government luulna ContraQlna Offlcer for the Conll'llct/PR No. Ul1ed In BklcJ( E.

A. CONTRACT LINE ITEM NO, B.EXHIBIT C.CATEGORY TBD

TM 011IEll

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

CNC Lathe (Project #601-832) TBD TBD

1. DATA ITEM NO.

I

2. TITLE OF DATA ITEM 3. SUBTITLE

B001 NRTL Certification OSHA Safety Certification

4. AUTHORITY (Oat. Acqula/Uon OoeulMflt NoJ 5. CONTRACT REFERENCE I. REQUIRING OFFICE

TBD NIA PSNS & IMF. Bangor - C830E

7. D0250REQ I. DtSTSTATEMEHT 1D. FREQUENCY 12. DATE OFRRST 14. DISTRIBUTION

NO REQUIRED SUBMISSION See Block 16 SEE BLOCK 16 SEEBLOCK16 b. COP1£!1

17. Pl

8. APPCODE N/R 11. AS OF DATE 13. DATE OF SUBSEQUENT A. ADDRESSEE Final

NIA SUBMISSION

N/A N/A Draft Reg Repr 19,E:

Tl

11. REMARKS See Block 16

Block 3: The NRn (NaUonally Recognized Testing Laboratory) certlflcaUon reports shall be In an appropriate format, but shall Include all required Items Included In content section (paragraph 2.2) on page two of this document A NRTL sticker shall be mounted on each of the CNC Lathe.

Blocks 10 & 12 & 14: The Contractor shall provide a copy of the certlflcaUon report and NRn Sticker for the CNC Lathe, prior to final acceptance.

TOTAL 1

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

Carl Jaeckel 11 Jul 19 Carl Jaeckel 11 Jul 19

DD Form 1423-1, FEB 2001 previous edition may be used. Page _1 _ of _2_ Pages

0006AB B

0006AC C

C001