DD1423.doc

Template last updated 09/29/2017

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 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 (0704-1088). 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: MICS

D. SYSTEM/ITEM

Permin Elmer Nexion 2000 ICPMS maintenance

E. CONTRACT/PR NO.

W911QX24P0093 / 0012109099

F. CONTRACTOR

PERKINELMER U.S. LLC

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Maintenance Report

3. SUBTITLE

Status Report

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80368

5. CONTRACT REFERENCE

C.4.1.1

6. REQUIRING OFFICE

FCDD-RLA-MF

7. DD 250 REQ

LT

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

AS REQ (see blk 16)

12. DATE OF FIRST SUBMISSION

see blk 16 14.

DISTRIBUTION

8. APP CODE

N/A

11. AS OF DATE

see blk 16

13. DATE OF SUBSEQUENT

SUBMISSION see blk 16

16. REMARKS

EACH REPORT SHALL BE DELIVERED IN PAPER OR ELECTRONICALLY, IN DIGITAL FORMAT OF MICROSOFT WORD, MICROSOFT OFFICE, MICROSOFT EXCEL, OR .PDF FORMAT.

CONTRACTOR FORMAT ACCEPTABLE.

BLKS 10, 11, 12, AND 13: IN ACCORDANCE WITH (IAW) THE PWS, REPORT OF FINDINGS FROM MAINTENANCE REPORTS SHALL BE DELIVERED WITHIN 10 DAYS OF COMPLETED SERVICE

DOCUMENTATION SHALL BE SENT TO:

UNITED STATES ARMY RESEARCH LABORATORY

SHIPPING AND RECEIVING

FCDD-RLA-MD

6375 JOHNSON ROAD, BLDG 321

ABERDEEN PROVING GROUND MD 21005

DR. Joseph Labukas Joseph.p.labukas.civ@army.mil

15. TOTAL

G. PREPARED BY

Dr. Joseph Labukas

H. DATE

03/20/2024

I. APPROVED BY

Swati Jain

J. DATE

04/08/2024

DD FORM 1423-1, FEB 2001

PREVIOUS EDITION MAY BE USED.

Page of Pages

EXHIBIT A – ATTACHMENT 1

ARMY RESEARCH LABORATORY

Report Title Goes Here

Any Subtitles Go Here

By Some Author and Another Author

Month XXXX

Prepared by

Whatever Technology Corporation

0000 Research Drive

Anywhere, ST 20006-1000

Under contract

W911QX-XX-C-XXXX

DISTRIBUTION STATEMENT GOES HERE

EXHIBIT A – ATTACHMENT 2

The findings in this report are not to be construed as an official Department of the Army position unless so designated by other authorized documents.

Citation of manufacturer's or trade names does not constitute an official endorsement or approval of the use thereof.

DESTRUCTION NOTICE: For classified documents, follow the procedures in DoD 5220.22-M, National Industrial Security Program Operating Manual, Chapter 5, Section 7. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.