Contract_Data_List_Requirements.doc

Template last updated 02/27/2015

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item) 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 collecton 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 (0704-1088). 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

A

C. CATEGORY:

TDP_____ TM ______ OTHER: NDTI

D. SYSTEM/ITEM

HTHW MAINTENANCE

E. CONTRACT/PR NO.

0010737301

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

Inspection, Maintenance, and Test Reports

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

C.5.1

6. REQUIRING OFFICE

IMAL-PWF

7. DD 250 REQ

N/A

9. DIST STATEMENT

REQUIRED

TBD

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION See block 16

14.

DISTRIBUTION

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION See block 16

16. REMARKS

The Contractor shall provide Inspection, Maintenance, and Test Reports, in accordance with Section C.5.1 of the Performance Work Statement (PWS):

The Contractor shall provide an Inspection and Testing form, within two (2) weeks after the completion of an inspection or test. Records shall be completed for all inspections, tests, and maintenance, and shall include results from testing performed, the organization that performed the work, the results, and the date completed.

Contractor format is acceptable.

IMAL-PWF

15. TOTAL

G. PREPARED BY

Allison Murray

H. DATE

8/25/2015

I. APPROVED BY

Fatimata Diallo

J. DATE

DD FORM 1423-1, FEB 2001

PREVIOUS EDITION MAY BE USED.

Page of Pages

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item) 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 collecton 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 (0704-1088). 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

A

C. CATEGORY:

TDP_____ TM ______ OTHER: MGMT

D. SYSTEM/ITEM

HTHW MAINTENANCE

E. CONTRACT/PR NO.

001073730

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

Status Report

3. SUBTITLE

Schedule of Work

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80368

5. CONTRACT REFERENCE

C.5.2

6. REQUIRING OFFICE

IMAL-PWF

7. DD 250 REQ

N/A

9. DIST STATEMENT

REQUIRED

TBD

10. FREQUENCY

ONR/R

12. DATE OF FIRST SUBMISSION 1 WEEK ACA

14.

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION SEE BLOCK 16

16. REMARKS

The Contractor shall provide Inspection, Maintenance, and Test Reports, in accordance with Section C.5.2 of the Performance Work Statement (PWS):

The Contractor shall provide a schedule of work that incorporates all maintenance tasks and their corresponding frequencies. A draft copy of this schedule shall be provided to the COR one (1) week after contract award. The COR will return the schedule, with input/comments, to the Contractor within seven (7) days of receipt of the submission. The Contractor shall submit the final schedule, for approval, within seven (7) days of receipt of the plan with COR comments. The schedule of work shall be approved before work begins. This deliverable applies to the base year of the contract, and each individual option year exercised.

Contractor format is acceptable.

G. PREPARED BY

H. DATE

8/25/2015

I. APPROVED BY

J. DATE

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item) 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 collecton 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 (0704-1088). 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

A

C. CATEGORY:

TDP_____ TM ______ OTHER: MISC

D. SYSTEM/ITEM

HTHW MAINTENANCE

E. CONTRACT/PR NO.

001073730

F. CONTRACTOR

TBD

1. DATA ITEM NO.

2. TITLE OF DATA ITEM

Scientific and Technical Reports

3. SUBTITLE

Accident Prevention Plan

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-80711A

5. CONTRACT REFERENCE

C.5.3

6. REQUIRING OFFICE

IMAL-PWF

7. DD 250 REQ

N/A

9. DIST STATEMENT

REQUIRED

TBD

10. FREQUENCY

ONR/R

12. DATE OF FIRST SUBMISSION 1 WEEK ACA

14.

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION SEE BLOCK 16

16. REMARKS

The Contractor shall provide Inspection, Maintenance, and Test Reports, in accordance with Section C.5.2 of the Performance Work Statement (PWS):

The Contractor shall develop an accident prevention plan in accordance with EM 385-1-1, Appendix A, and provide a draft copy to the COR one (1) week after contract award. The accident prevention plan will be reviewed for completeness and compliance with OSHA and EM 385-1-1. The COR will return the accident prevention plan, with input/comments, to the Contractor within seven (7) days of receipt of the submission. The Contractor shall submit the final accident prevention plan, for approval, within seven (7) days of receipt of the plan with COR comments. The accident prevention plan shall be approved before work begins.

Contractor format is acceptable.

G. PREPARED BY

H. DATE

8/25/2015

I. APPROVED BY

J. DATE