Exhibit A - Contract Data Requirements List - Amendment 0002.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 OMB Approval Expires 20221130

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

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

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: A001 title: Engineering Change Proposal (ECP) sub:

auth: DI-SESS-80639E ref: SOW 5.2.1 req_ofc: FCDD-ACE-QMG dd250: LT appcode:

dist: C freq: As Required asof: As Required firstsub: As Required subsub: As Required addressee1: SFAE-AA-CCS draft1:

reg1: 1 repro1:

addressee2: FCDD-ACM-ML draft2:

reg2: 1 repro2:

addressee3: FCDD-ACE-QMG draft3:

reg3: 1 repro3:

addressee4: FCDD-ACE-QPB draft4:

reg4: 1 repro4:

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total_draft: 0 total_reg: 4 total_repro: 0 remarks: BLK 9: DISTRIBUTION STATEMENT C: DISTRIBUTION

AUTHORIZED TO US GOV'T AGENCIES AND THEIR

CONTRACTORS; CRITICAL TECHNOLOGY; 11 MARCH 2013.

OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED

TO CCNJ-ET PCO BLDG.10 PICATINNY ARSENAL, NJ 07806-5000

BLK12:

Requests for ECPs shall be submitted utilizing DD Form 1692. If the contractor wishes to use configuration management forms other than those listed above, the proposed alternate forms shall be submitted for approval prior to use. The contractor shall submit all ECP’s in accordance with DI-SESS-80639D. The contractor shall submit to the Government for review and approval any changes to PMCCS’s approved drawings, or specifications (as detailed in section C.4.1 of the SOW). Any submission shall address ozone depleting chemicals (ODC’s) as required by Public Law 102-484, Section 326.

The Government will respond to Class I ECPs within 10 business days if additional information is required for the review and approval process. If clarification or more information is required from the contractor, the response period will re-start once the Government is provided with the necessary information. The Government will provide a disposition on ECPs within 30 days of receipt, or within 30 days of receipt of revised information, whichever is later.

Class II ECPs will be provided for concurrence on class II status. If the Government determines that the class II ECP was inaccurately identified and meets the criteria of a class I ECP the contractor shall be notified within ten (10) days with rational for the determination. If this occurs the Government reserves the right to reject the ECP and request that it be submitted as a class I ECP.

Class II ECPs will be provided on an informational only basis only for administrative changes. If the government determines that the class II ECP is not administrative in nature, the contractor shall be notified within ten (10) days. If this occurs the Government reserves the right to reject the ECP and request that it be submitted as a class I or Class II ECP. If this does not occur, no notice shall be sent.

See next page.

All submissions shall be in English.

group:

total_price:

prep_name:

line_item:

exhibit:

xtdp: Off xtm: Off othercat:

system: XM919 Individual Assault Munition (IAM) ctr_no:

contr:

remarksb:

Page2:

Reset:

2023-05-11T07:04:00-0400

MALONE.ADAM.WILLIAM.1028008917

prep_date: 5/11/2023 app_by:

2023-10-20T13:52:12-0400

WADLE.KENNETH.GEORGE.1030254356

app_date:

Page: 1 of_pages: 1 app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A019 title: Critical Plan of Action (CPOA) sub:

auth: DI-MGMT-81996 ref: SOW C.5.3.14& QA Addendum req_ofc: FCDD-ACE-QMG dd250: LT appcode:

dist: C freq: As Required asof: As Required firstsub: See Blk 16 subsub: See Blk 16 addressee1: ACC-NJ-CC draft1:

reg1: 1 repro1:

addressee2: SFAE-AMO-CCS draft2:

reg2: 1 repro2:

addressee3: FCDD-ACM-ML draft3:

reg3: 1 repro3:

addressee4: FCDD-ACE-QMG draft4:

reg4: 1 repro4:

addressee5: FCDD-ACE-QPB draft5:

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total_draft: 0 total_reg: 7 total_repro: 0 remarks: BLK 9: DISTRIBUTION STATEMENT C: DISTRIBUTION

AUTHORIZED TO US GOV'T AGENCIES AND THEIR

CONTRACTORS; CRITICAL TECHNOLOGY; 11 MARCH 2013.

OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED

TO ACC-NJ-CC PCO BLDG.10 PICATINNY ARSENAL, NJ 07806-

BLOCK 10: Contractor may voluntarily submit a CPOA for all critical characteristics as specified in the contract clause reference.

BLOCK 12: Contractor shall submit the CPOA for approval prior to use. Government will respond within 45 days of receipt of original and any required revisions.

Unless otherwise specified, contractor shall submit revisions within 10 days of receipt of Government response. Unless otherwise approved by the PCO, the CPOA is not authorized for use prior to Government approval.

BLOCK 13: Unless otherwise specified, if the CPOA changes after initial Government approval, Contractor shall resubmit revised plan for Government approval.

BLOCK 14: Electronic submission is suggested with electronic mail transfer as the preferred format. Should the volume of data to be submitted exceed the limits of electronic mail transfer, submission using compact disk with .PDF file format is acceptable. regardless of submission method selected, file format used must be compatible with Microsoft Office.

BLOCK 14: DISTRIBUTION - SEE ATTACHED CDRL DISTRIBUTION

POINT OF CONTACT LIST PROVIDED AS AN ATTACHMENT

All submissions shall be in English.

group:

total_price:

prep_name:

line_item:

exhibit:

xtdp: Off xtm: Off othercat:

system: XM919 Individual Assault Munition (IAM) ctr_no:

contr:

remarksb:

Page2:

Reset:

2023-02-22T11:03:17-0500

MALONE.ADAM.WILLIAM.1028008917

prep_date: 2/22/2023 app_by:

2023-07-17T14:09:45-0400

WADLE.KENNETH.GEORGE.1030254356

app_date:

Page: 1 of_pages: 1 app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A020 title: Management sub: Process Control Plan auth: DI-MGMT-80004A ref: SOW C.5.3.17 & QA Addendum req_ofc: FCDD-ACM-ML dd250: LT appcode:

dist: C freq: As Required asof: As Required firstsub: See Blk 16 subsub: As Required addressee1: CCNJ-ET draft1:

reg1: 1 repro1:

addressee2: SFAE-AA-CCS draft2:

reg2: 1 repro2:

addressee3: FCDD-ACM-ML draft3:

reg3: 1 repro3:

addressee4: FCDD-ACE-QMG draft4:

reg4: 1 repro4:

addressee5: FCDD-ACE-QPB draft5:

reg5: 1 repro5:

addressee6: PM AMMO draft6:

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total_draft: 0 total_reg: 7 total_repro: 0 remarks: BLK 9: DISTRIBUTION STATEMENT C: DISTRIBUTION

AUTHORIZED TO US GOV'T AGENCIES AND THEIR

CONTRACTORS; CRITICAL TECHNOLOGY; 11 MARCH 2013.

OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED

TO ACC-NJ-CC PCO BLDG.10 PICATINNY ARSENAL, NJ 07806-

BLOCK 12&13 In addition to the quality requirements of the technical data package, the Contractor shall implement Process Capability, Control & Improvement (PCCI) in accordance with a government accepted Process Control Plan. Plan shall be in two sections General and Detailed and submitted to the Government for review and acceptance 60 days prior to start of FAT.

The Government will provide approval/disapproval for the plan within 15 days of receipt.

BLOCK 14: Electronic submission is suggested with electronic mail transfer as the preferred format. Should the volume of data to be submitted exceed the limits of electronic mail transfer, submission using compact disk with .PDF file format is acceptable. regardless of submission method selected, file format used must be compatible with Microsoft Office.

group:

total_price:

prep_name:

line_item:

exhibit:

xtdp: Off xtm: Off othercat:

system: XM919 Individual Assault Munition (IAM) ctr_no:

contr:

remarksb:

Page2:

Reset:

2023-02-23T08:51:50-0500

MALONE.ADAM.WILLIAM.1028008917

prep_date: 2/23/2023 app_by:

2023-07-17T14:10:11-0400

WADLE.KENNETH.GEORGE.1030254356

app_date:

Page: 1 of_pages: 1 app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A012 title: Test Report sub: Lot Acceptance Test (LAT) auth: DI-NDTI-80809B ref: SOW 5.3.8 req_ofc: FCDD-ACE-QMG dd250: LT appcode:

dist: C freq: See Blk 16 asof: As Required firstsub: See Blk 16 subsub: As Required addressee1: SFAE-AA-CCS draft1:

reg1: 1 repro1:

addressee2: FCDD-ACM-ML draft2:

reg2: 1 repro2:

addressee3: FCDD-ACE-QMG draft3:

reg3: 1 repro3:

addressee4: FCDD-ACE-QPB draft4:

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total_draft: 0 total_reg: 4 total_repro: 0 remarks: BLK 9: DISTRIBUTION STATEMENT C: DISTRIBUTION

AUTHORIZED TO US GOV'T AGENCIES AND THEIR

CONTRACTORS; CRITICAL TECHNOLOGY; 11 MARCH 2013.

OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED

TO CCNJ-ET PCO BLDG.10 PICATINNY ARSENAL, NJ 07806-5000

The Contractor shall submit test report for Lot Acceptance Test (LAT) 30 days after completing testing, BLK 14:

Electronic submission is suggested with electronic mail transfer as the preferred format.

Should the volume of data to be submitted exceed the limits of electronic mail transfer, submission using compact disk with .PDF file format is acceptable. Regardless of submission method selected, file format used must be compatible with Microsoft Office.

DISTRIBUTION - SEE ATTACHED CDRL DISTRIBUTION

POINT OF CONTACT LIST PROVIDED AS AN ATTACHMENT

All submissions shall be in English.

group:

total_price:

prep_name:

line_item:

exhibit:

xtdp: Off xtm: Off othercat:

system: XM919 Individual Assault Munition (IAM) ctr_no:

contr:

remarksb:

Page2:

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2023-02-22T10:56:09-0500

MALONE.ADAM.WILLIAM.1028008917

prep_date: 2/22/2023 app_by:

2023-10-20T13:55:17-0400

WADLE.KENNETH.GEORGE.1030254356

app_date:

Page: 1 of_pages: 1 app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A017 title: Critical Characteristics Control Plan (CCCP) sub:

auth: DI-MGMT-81986 ref: SOW C.5.3.14 & QA Addendum req_ofc: FCDD-ACE-QMG dd250: LT appcode:

dist: C freq: As Required asof: As Required firstsub: See Blk 16 subsub: See Blk 16 addressee1: ACC-NJ-CC draft1:

reg1: 1 repro1:

addressee2: SFAE-AMO-CCS draft2:

reg2: 1 repro2:

addressee3: FCDD-ACM-ML draft3:

reg3: 1 repro3:

addressee4: FCDD-ACE-QMG draft4:

reg4: 1 repro4:

addressee5: FCDD-ACE-QPB draft5:

reg5: 1 repro5:

addressee6: PM AMMO draft6:

reg6: 1 repro6:

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total_draft: 0 total_reg: 7 total_repro: 0 remarks: BLK 9: DISTRIBUTION STATEMENT C: DISTRIBUTION

AUTHORIZED TO US GOV'T AGENCIES AND THEIR

CONTRACTORS; CRITICAL TECHNOLOGY; 11 MARCH 2013.

OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED

TO ACC-NJ-CC PCO BLDG.10 PICATINNY ARSENAL, NJ 07806-

Block 12 & 13: Submission for Government approval due NLT sixty (60) days prior to FAT.

If changes occur after initial approval, submit revisions for approval within ten (10) days of any revisions.

The Government will respond within thirty (30) days of receipt of first submittal and within ten (10) days of all revisions and subsequent submittals.

Contractor shall respond within ten (10) days of receipt of Government response

BLOCK 14: Electronic submission is suggested with electronic mail transfer as the preferred format. Should the volume of data to be submitted exceed the limits of electronic mail transfer, submission using compact disk with .PDF file format is acceptable. regardless of submission method selected, file format used must be compatible with Microsoft Office.

BLOCK 14: DISTRIBUTION - SEE ATTACHED CDRL DISTRIBUTION

POINT OF CONTACT LIST PROVIDED AS AN ATTACHMENT

All submissions shall be in English.

group:

total_price:

prep_name:

line_item:

exhibit:

xtdp: Off xtm: Off othercat:

system: XM919 Individual Assault Munition (IAM) ctr_no:

contr:

remarksb:

Page2:

Reset:

2023-02-22T11:02:09-0500

MALONE.ADAM.WILLIAM.1028008917

prep_date: 2/22/2023 app_by:

2023-10-20T13:56:48-0400

WADLE.KENNETH.GEORGE.1030254356

app_date:

Page: 1 of_pages: 1 app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A021 title: Accident/Incident Report sub:

auth: DI-SAFT-81563 ref: SOW C.5.3.18 req_ofc: FCDD-ACM-ML dd250: LT appcode:

dist: C freq: As Required asof: As Required firstsub: See Blk 16 subsub: As Required addressee1: ACC-NJ-CC draft1:

reg1: 1 repro1:

addressee2: SFAE-AA-CCS draft2:

reg2: 1 repro2:

addressee3: FCDD-ACM-ML draft3:

reg3: 1 repro3:

addressee4: FCDD-ACE-QMG draft4:

reg4: 1 repro4:

addressee5: FCDD-ACE-QPB draft5:

reg5: 1 repro5:

addressee6: PM AMMO draft6:

reg6: 1 repro6:

addressee7: DCMA-QAR draft7:

reg7: 1 repro7:

addressee8:

draft8:

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total_draft: 0 total_reg: 7 total_repro: 0 remarks: BLK 9: DISTRIBUTION STATEMENT C: DISTRIBUTION

AUTHORIZED TO US GOV'T AGENCIES AND THEIR

CONTRACTORS; CRITICAL TECHNOLOGY; 11 MARCH 2013.

OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED

TO ACC-NJ-CC PCO BLDG.10 PICATINNY ARSENAL, NJ 07806-

The contractor shall report immediately any major accident/incident (including fire) resulting in any one or more of the following: causing one or more fatalities, or one or more disabling injuries; damage of Government property exceeding $10,000; affecting program planning or production schedules; degrading the safety of equipment under contract, such that personal injury or property damage may be involved;

identifying a potential hazard requiring corrective action. The contractor shall prepare the report IAW DI-SAFT-81563 for each incident.

BLOCK 14: Electronic submission is suggested with electronic mail transfer as the preferred format. Should the volume of data to be submitted exceed the limits of electronic mail transfer,The contractor shall report immediately any major accident/incident (including fire) resulting in any one or more of the following: causing one or more fatalities, or one or more disabling injuries; damage of Government property exceeding $10,000; affecting program planning or production schedules; degrading the safety of equipment under contract, such that personal injury or property damage may be involved;

identifying a potential hazard requiring corrective action. The contractor shall prepare the report IAW DI-SAFT-81563 for each incident.

group:

total_price:

prep_name:

line_item:

exhibit:

xtdp: Off xtm: Off othercat:

system: XM919 Individual Assault Munition (IAM) ctr_no:

contr:

remarksb:

Page2:

Reset:

2023-02-22T11:09:19-0500

MALONE.ADAM.WILLIAM.1028008917

prep_date: 2/22/2023 app_by:

2023-07-17T14:10:56-0400

WADLE.KENNETH.GEORGE.1030254356

app_date:

Page: 1 of_pages: 1 app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A022 title: Bill of Materials (BOM) for Logistics and Supply Chain Risk Management sub:

auth: DI-MISC-80048 ref: SOW C.5.4.1 req_ofc: FCDD-ACM-ML dd250: LT appcode:

dist: C freq: As Required asof: As Required firstsub: See Blk 16 subsub: As Required addressee1: ACC-NJ-CC draft1:

reg1: 1 repro1:

addressee2: SFAE-AA-CCS draft2:

reg2: 1 repro2:

addressee3: FCDD-ACM-ML draft3:

reg3: 1 repro3:

addressee4: FCDD-ACE-QMG draft4:

reg4: 1 repro4:

addressee5: FCDD-ACE-QPB draft5:

reg5: 1 repro5:

addressee6: PM AMMO draft6:

reg6: 1 repro6:

addressee7: DCMA-QAR draft7:

reg7: 1 repro7:

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total_draft: 0 total_reg: 7 total_repro: 0 remarks: BLK 9: DISTRIBUTION STATEMENT C: DISTRIBUTION

AUTHORIZED TO US GOV'T AGENCIES AND THEIR

CONTRACTORS; CRITICAL TECHNOLOGY; 11 MARCH 2013.

OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED

TO ACC-NJ-CC PCO BLDG.10 PICATINNY ARSENAL, NJ 07806-

Block 12:

90 days after contract award.

The contractor shall submit a well-constructed program set of BOMs.

BOM shall include the following data:

• Supply Chain Mapping Data – Excel spreadsheet (ATTACHMENT - 002).

• The contractor shall trace down the indentured BOM for all military items used for this procurement to the lowest tier possible or until a proprietary roadblock is encountered.

• The contractor shall further supplement the indentured BOM with all commercially available product items down to the lowest tier possible in the supply chain.

• Contractor shall include breakdown of raw material, precursor level, element, and constituents. Applies to the prime and their suppliers, sub-contractors, associated integrators and vendors spanning down to the lowest tier possible in the supply chain, from raw material stage to delivery of a finished product and/or service.

group:

total_price:

prep_name:

line_item:

exhibit:

xtdp: Off xtm: Off othercat:

system: XM919 Individual Assault Munition (IAM) ctr_no:

contr:

remarksb:

Page2:

Reset:

2023-04-20T13:16:55-0400

MALONE.ADAM.WILLIAM.1028008917

prep_date: 04/20/2023 app_by:

2023-07-17T14:11:25-0400

WADLE.KENNETH.GEORGE.1030254356

app_date:

Page: 1 of_pages: 1 app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A029 title: Hazardous Waste Report sub:

auth: DI-MGMT-82129 ref: SOW C.5.5.5 req_ofc: FCDD-ACM-ML dd250: LT appcode:

dist: C freq: As Required asof: As Required firstsub: See Blk 16 subsub: See Blk 16 addressee1: ACC-NJ-CC draft1:

reg1: 1 repro1:

addressee2: SFAE-AMO-CCS draft2:

reg2: 1 repro2:

addressee3: FCDD-ACM-ML draft3:

reg3: 1 repro3:

addressee4: FCDD-ACE-QMG draft4:

reg4: 1 repro4:

addressee5: FCDD-ACE-QPB draft5:

reg5: 1 repro5:

addressee6: PM AMMO draft6:

reg6: 1 repro6:

addressee7: DCMA-QAR draft7:

reg7: 1 repro7:

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draft8:

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total_draft: 0 total_reg: 7 total_repro: 0 remarks: BLK 9: DISTRIBUTION STATEMENT C: DISTRIBUTION

AUTHORIZED TO US GOV'T AGENCIES AND THEIR

CONTRACTORS; CRITICAL TECHNOLOGY; 11 MARCH 2013.

OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED

TO ACC-NJ-CC PCO BLDG.10 PICATINNY ARSENAL, NJ 07806-

Block: 12 & 13: Submission for Government review and approval is due NLT ninety (90) days after contract award and annually following first submission.

If changes occur after initial approval, submit revisions for approval within ten (10) days of any revisions.

The Government will respond within thirty (30) days of receipt of first submittal and within ten (10) days of all revision or subsequent submittals.

Contractor shall respond within ten (10) days of receipt of Government response.

BLOCK 14: Electronic submission is suggested with electronic mail transfer as the preferred format. Should the volume of data to be submitted exceed the limits of electronic mail transfer, submission using compact disk with .PDF file format is acceptable. regardless of submission method selected, file format used must be compatible with Microsoft Office.

All submissions shall be in English.

group:

total_price:

prep_name:

line_item:

exhibit:

xtdp: Off xtm: Off othercat:

system: XM919 Individual Assault Munition (IAM) ctr_no:

contr:

remarksb:

Page2:

Reset:

2023-02-23T08:12:07-0500

MALONE.ADAM.WILLIAM.1028008917

prep_date: 5/15/2023 app_by:

2023-10-20T13:57:42-0400

WADLE.KENNETH.GEORGE.1030254356

app_date:

Page: 1 of_pages: 1 app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of production or development fo