MIOSS_Exhibit_I_B009_CDRL_Contractor and Subcontractor Personnel Roster.pdf
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- Attached to
- The Medical Simulation Training Center (MSTC), Instructor, Operator Support Services (MIOSS) acquisition
- Solicitation number
- W900KK-23-R-0016
About this file
This document contains a Contract Data Requirements List (CDRL) and information on a related federal contract opportunity. The CDRL outlines requirements for a Contractor and Subcontractor Personnel Roster to be delivered on a quarterly basis under contract number W900KK-XX-X-XXXX. It specifies the format, content, and distribution instructions for the roster. Additionally, solicitation number W900KK-23-R-0016 seeks proposals for Medical Instructor and Operator Support Services (MIOSS) to support Medical Simulation Training Centers. The firm-fixed-price contract would have a total period of performance of four years and eight months, including a two-month phase-in and four one-year option periods. The services involve education and training using medical simulation equipment but not direct patient treatment. The opportunity is set aside for small businesses under NAICS code 541990 with a size standard of $16.5 million. Proposals are due through SAM.gov in response to this solicitation.
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Text version
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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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
A MGMT
MIOSS W900KK-XX-X-XXXX
B009 CONTRACTOR AND SUBCONTRACTOR
PERSONNEL ROSTER
DI-MGMT-81834A SEE BLK 16 SFAE-STRI-TSO
LT
N/A E
QTRLY
N/A
SEE BLK 16
SEE BLK 16
SEE BLK 16
0 0 0
1. BLOCK 4: PWS PARAGRAPH WILL IDENTIFY THE TYPE OF
TECHNICAL REPORT REQUIRED. DID PARAGRAPH 2 FORMAT:
CONTRACTOR FORMAT IS ACCEPTABLE USING THE CURRENT
GOVERNMENT VERSION OF MICROSOFT OFFICE. CONTENT FOR
ROSTER SHALL CONTAIN AN ALPHABETICAL LISTING OF THE NAMES
OF ALL CONTRACTOR AND SUBCONTRACTOR PERSONNEL
ASSIGNED.
THE ROSTER SHALL IDENTIFY THE FOLLOWING FOR EACH
EMPLOYEE:
a. CHANGE STATUS: ADD/CHANGE/REMOVE
b. START DATE
c. END DATE
d. FIRST NAME
e. MIDDLE NAME
f. LAST NAME
g. POSITION TITLE
h. EMAIL ADDRESS
i. WORK PHONE NUMBER
j. PHYSICAL WORK LOCATION - BASE NAME
k. PHYSICAL WORK LOCATION - CITY
l. PHYSICAL WORK LOCATION - STATE
m. PHYSICAL WORK LOCATION - BUILDING NUMBER
n. PHYSICAL WORK LOCATION - ROOM NUMBER
o. CONTRACT NUMBER
p. CONTRACT NAME
q. CONTRACTING SUPERVISOR
r. GOVERNMENT SUPPORT POC
s. SUPPORTING CODE
t. QUALIFICATION/CERTIFICATION COMPLIANT
2. BLOCK 5: SHALL ADDRESS TO BASE PWS PARAGRAPH 3.1.1.
7/14/2022 14 JUL 2022
1 2
STROUD.FRANKLIN.
GLENN.1202177472
Digitally signed by
STROUD.FRANKLIN.GLENN.1202
177472 Date: 2022.07.14 13:59:22 -04'00'
STEVENS.DARIN.
OWEN.1186676773
Digitally signed by
STEVENS.DARIN.OWEN.1186676
Date: 2022.07.14 16:05:37 -04'00'
DD FORM 1423-1, FEB 2001
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)
Page of Pages
A MGMT
MIOSS W900KK-XX-X-XXXX
3. BLOCK 8: THE GOVERNMENT WILL HAVE TWENTY (20) WORKING DAYS TO REVIEW AND ACCEPT OR REJECT EACH SUBMISSION. THE CONTRACTOR SHALL HAVE TEN (10) WORKING DAYS TO INCORPORATE GOVERNMENT
COMMENTS AND RESUBMIT.
4. BLOCK 9: DISTRIBUTION AUTHORIZED TO DoD COMPONENTS ONLY. OTHER REQUESTS MUST BE REFERRED TO
PEO STRI (SFAE-STRI-TSO).
WARNING: THIS DOCUMENT CONTAINS TECHNICAL DATA WHOSE EXPORT IS RESTRICTED BY THE ARMS EXPORT CONTROL ACT (TITLE 22, U.S.C., SEC. 2751, ET SEQ.) OR THE EXPORT ADMINISTRATION ACT OF 1979, AS AMENDED (TITLES 50, U.S.C., APP. 2401, ET SEQ.) VIOLATION OF THESE EXPORT LAWS ARE SUBJECT TO SEVERE CRIMINAL PENALTIES. DISSEMINATE IN ACCORDANCE WITH THE PROVISIONS OF DOD DIRECTIVE 5230.25.
5. BLOCK 12: FORTY-FIVE (45) CALENDAR DAYS AFTER CONTRACT AWARD.
6. BLOCK 13: TEN (10) WORKING DAYS AFTER ANY PERSONNEL CHANGE.
7. BLOCK 14a: PCO AND COR.
8. BLOCK 14b: SHALL BE DELIVERED IN MICROSOFT OFFICE FORMAT WITH AN EMAIL NOTIFICATION TO BLK 14a.
2 2
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