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CDRL A001

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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

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 (0704-0188). 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

1_DATA_ITEM_NO: A001
2_TITLE_OF_DATA_ITEM: De-Ionized water & water softener treatment
3_SUBTITLE:
4_AUTHORITY_Data_Acquisit: See Block 16
5_CONTRACT_REFERENCE: Performance Work Statement (PWS)
6_REQUIRING_OFFICE: USAG-Natick-NSRDEC
7_DID_250_REQ:
8_APP_CODE:
DIST_STATEMENT:
10_FREQUENCY: See Block 16
11_AS_OF_DATE:
12_DATE_OF_FIRST_SUBMISSI:
13_DATE_OF_SUBSEQUENT_SUB: submission
addressee1: USAG-Natick-NSRDEC
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16_REMARKS: Block 4: The contractor shall prepare a monthly list of equipment that was serviced and replaced for the month.

Block 16: Contractor shall submit documents the last working day of every month over the life of this contract.

The contractor shall list what maintenance, service and replaced items that were completed for the month.

The contractor shall describe in detail what work was performed on each piece of equipment.

The contractor shall submit all invoices for any items replaced on equipment.

Contractor shall submit documents electronically in PDF format.

17_PRICE_GROUP:
ESTIMATED_TOTAL_PRICE:
G_PREPARED_BY: Joshua Bulotsky
H_DATE: 30 Nov 2016
1_APPROVED_BY: Joshua Bulotsky
J_DATE: 30 Nov 2016
Page:
reg38t: 0
A_CONTRACT_LINE_ITEM_NO:
B_EXHIBIT: A
TDP:
TM:
OTHER: Maintenance & Service
DSYSTEMITEM: Water treatment Reporting
E_CONTRACTPR_NO:
FCONTRACTOR:
of_pages:
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