DD1423_A001_-_A013.pdf

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items)

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 220 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:

0008 A TDP TM OTHER DATA

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

POL SUPPORT FOR MOD W91B4N-17-R-0005 TBD

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

A001 DELIVERY TICKET

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

N/A 4.4.3 CSTC-A EF5.1.2

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

NO

8. APP CODE

N/A

REQUIRED

A

SEE BLK 16 ASREQ

11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

TBD

a. ADDRESSEE

Draft

b. COPIES

Final

Reg Repro

16. REMARKS

BLK 10: Contractor shall submit one (1) delivery ticket for each delivery.

BLK 12: Due 10 days after contract award.

BLK 14: Contractor format. Shall adhere to the requirements within the Statement of Work. Should be submitted in PDF by email to applicable addressees.

The Government shall have (5) days for review and acceptance/rejection. The Government shall process payment upon acceptance.

PCO 1

PJM 1

1. DATA ITEM NO. 2. TITLE OF DATA ITEM

DRIVER RECORD

15. TOTAL

0 2 0

A002

4. AUTHORITY (Data Acquisition Document No.)

7. DD 250 REQ

NO

8. APP CODE

N/A

16. REMARKS

9. DIST STATEMENT

10. F

11. AS

BLK 12: Contractor shall submit upon Go

BLK 14: Contractor format. Shall adhere t Work. Should be submitted in PDF by e

The Government shall confirm receipt wit

G. PREPARED BY

DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAY BE USED. Page 1 of 6 Pages Adobe Professional 8.0

17. PRICE GROUP

NSP

18. ESTIMATED

TOTAL PRICE

TOTAL PRICE

Reset

3. SUBTITLE

5. CONTRACT REFERENCE 6. REQUIRING OFFICE

4.4.6 CSTC-A EF5.1.2

EQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

ASREQ SEE BLK 16

OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE

SUBMISSION

TBD

PCO

vernment's request. PJM o the requirements within the Statement of ail to applicable addressees.

hin 2 days.

Reg

Repro

H. DATE I. APPROVED BY

0 2

J. DATE

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

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 1423-2 (BACK), AUG 96

The public reporting burden for this collection of information is estimated to average 220 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:

0008 A TDP TM OTHER DATA

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

POL SUPPORT FOR MOD W91B4N-17-R-0005 TBD

A003 QUALITY CONTROL PLAN (QCP)

N/A 4.5.1 CSTC-A EF5.1.2

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

NO

8. APP CODE

ONE/R See BLK 16

11. AS OF DATE 13. DATE OF SUBSEQUENT

R/ASR

Reg Repro

16. REMARKS

BLK 12: Due 10 days after contract award.

BLK 14: Contractor format. Shall adhere to the requirements within the Statement of Work. Should be submitted in PDF by email to applicable addressees.

The Government shall have 15 days for review and acceptance/rejection.

PCO 1 1

PJM 1 1

MoCI CERTIFICATIO

2 2 0

A004

7. DD 250 REQ

NO

8. APP CODE

N/A

16. REMARKS

BLK 12: Contractor shall certify that all P contaminants and will provide Ministry of quality as required.

BLK 14: MoCI Certification of Fuel Qual applicable addressees.

The Government shall have 2 days for rev

DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAY BE USED. Page 2 of 6 Pages

TOTAL PRICE

Reset

N OF FUEL QUALITY

4.5.1 CSTC-A EF5.1.2

EQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

ASREQ SEE BLK 16

OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE

SUBMISSION

ASREQ

PCO

OL products shipped shall be free of PJM Commerce & Industry MoCI certification of fuel

ty. Should be submitted in PDF by email to

Reg ew and acceptance/rejection.

15. TOTAL 0 2 0

H. DATE I. APPROVED BY J. DATE

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 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies in Item 14.; Desired medium conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the and does not require any substantial change to conform to Government requirements with regard to depth of content, format, 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

The public reporting burden for this collection of information is estimated to average 220 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:

0008 A TDP TM OTHER DATA

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

POL SUPPORT FOR MOD W91B4N-17-R-0005 TBD

A005 BATCH QUALITY CONTROL DOCUMENTS

N/A 4.6.2 CSTC-A EF5.1.2

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

NO

8. APP CODE

MTHLY SEE BLK 16

11. AS OF DATE 13. DATE OF SUBSEQUENT

MTHLY

Reg Repro

BLK 12: Due to the Government monthly with submission of invoices.

BLK 14: Applicable refinery format is acceptable. Shall be submitted in PDF by email to applicable addressees.

The Government shall have five (5) days for review and acceptance/rejection. The Government shall process payment upon acceptance.

MAINTENANCE REC

A006

7. DD 250 REQ

NO

9. DIST STATEMENT

REQUIRED

10. F

S

8. APP CODE

N/A

16. REMARKS

A 11. AS

BLK 10: Shall be submitted to Governme

BLK 14: Contractor format is acceptable.

by email to applicable addressees.

The Government shall confirm receipt wit

DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAY BE USED. Page 3 of 6 Pages

TOTAL PRICE

Reset

ORDS

4.7.1 CSTC-A EF5.1.2

EQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

EE BLK 16 ASREQ

OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE

SUBMISSION

ASREQ

PCO

nt upon request. PJM

Shall be in English. Shall be submitted in PDF hin two (2) days of submission.

Reg

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 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies in Item 14.; Desired medium conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the and does not require any substantial change to conform to Government requirements with regard to depth of content, format, 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

The public reporting burden for this collection of information is estimated to average 220 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:

0008 A TDP TM OTHER DATA

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

POL SUPPORT FOR MOD W91B4N-17-R-0005 TBD

A007 VEHICLE LIST

N/A 4.7.3 CSTC-A EF5.1.2

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

NO

8. APP CODE

MNTHLY SEE BLK 16

11. AS OF DATE 13. DATE OF SUBSEQUENT

MNTHLY

Reg Repro

BLK 14: Contractor format is acceptable. Shall be submitted IAW the Statement of Work.

Shall be submitted in PDF by email to applicable addressees.

DAILY DELIVERY R

A008

7. DD 250 REQ

NO

9. DIST STATEMENT

REQUIRED

10. F

S

8. APP CODE

N/A

16. REMARKS

BLK 10: Shall be submitted daily by 2000

BLK 12: Shall be submitted upon Delivery Order.

BLK 14: Contractor format is acceptable. S Statement of Work. Shall be submitted in P

The Government shall have one (1) day

DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAY BE USED. Page 4 of 6 Pages

TOTAL PRICE

Reset

PORT

CSTC-A EF5.1.2

EQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

EE BLK 16 SEE BLK 16

OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE

SUBMISSION

ASREQ

PCO

local time. PJM

Order award and throughout the Delivery hall adhere to the requirements IAW the

Reg

Repro

DF by email to applicable addressees.

r review and acceptance/rejection.

15. TOTAL 0 2 0

H. DATE I. APPROVED BY J. DATE

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 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies in Item 14.; Desired medium conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the and does not require any substantial change to conform to Government requirements with regard to depth of content, format, 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

The public reporting burden for this collection of information is estimated to average 220 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:

0008 A TDP TM OTHER DATA

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

POL SUPPORT FOR MOD W91B4N-17-R-0005 TBD

A009 CERTIFICATE OF ORIGIN

N/A 5.3.3 CSTC-A EF5.1.2

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

NO

8. APP CODE

MTHLY SEE BLK 16

11. AS OF DATE 13. DATE OF SUBSEQUENT

MTHLY

Reg Repro

BLK 14: Applicable commercial industry format is acceptable. Shall be submitted IAW the Statement of Work. Shall be submitted in PDF by email to applicable addressees. For each bulk purchase.

QUALITY AND QUA

A010

7. DD 250 REQ

NO

9. DIST STATEMENT

REQUIRED

10. F

S

8. APP CODE

N/A

BLK 10:

BLK 12:

BLK 13:

BLK 14:

DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAY BE USED. Page 5 of 6 Pages

TOTAL PRICE

Reset

NTITY RECORDS

5.3.5 CSTC-A EF5.1.2

EQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

EE BLK 16 SEE BLK 16

OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE

SUBMISSION

SEE BLK 16

PCO

PJM

Reg

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 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies in Item 14.; Desired medium conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the and does not require any substantial change to conform to Government requirements with regard to depth of content, format, 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

The public reporting burden for this collection of information is estimated to average 220 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:

0008 A TDP TM OTHER DATA

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

POL SUPPORT FOR MOD W91B4N-17-R-0005 TBD

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

A011 OTHER DOCUMENTATION: VEHICLE LOGS,

CALIBRATION TESTS

RESULTS OF QUALITY OR QUANTITY

DISCREPANCY INVESTIGATIONS

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

N/A 5.3.3 CSTC-A EF5.1.2

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

NO

8. APP CODE

ASREQ SEE BLK 16

11. AS OF DATE 13. DATE OF SUBSEQUENT

Reg Repro

BLK 12: Applicable documents are due to the Government when requested.

BLK 14: Contractor format is acceptable. Shall be submitted in PDF by email to applicable addressees.

The Government shall have two (2) days to confirm receipt of documentation.

ANTI/COUNTER COR

A012

7. DD 250 REQ

NO

8. APP CODE

N/A

16. REMARKS

BLK 12: Due 15 days after contract

BLK 14: Contractor format. Shall adhere t Work. Should be submitted in PDF by e

The Government shall have 15 days for re

DD FORM 1423-2, AUG 96 PREVIOUS EDITION MAY BE USED. Page 6 of 6 Pages

TOTAL PRICE

Reset

RUPTION PLAN (ACCP)

5.3.5 CSTC-A EF5.1.2

EQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

ONE/R SEE BLK 16

OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE

SUBMISSION

R/ASR

PCO

. PJM

o the requirements within the Statement of ail to applicable addressees.

view and acceptance/rejection.

Final

Reg

2 2

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 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies in Item 14.; Desired medium conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the and does not require any substantial change to conform to Government requirements with regard to depth of content, format, 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

DD FORM 1423-2 (BACK), AUG 96

DD FORM 1423-2 (BACK), AUG 96

DD FORM 1423-2 (BACK), AUG 96

DD FORM 1423-2 (BACK), AUG 96

DD FORM 1423-2 (BACK), AUG 96

DD FORM 1423-2 (BACK), AUG 96