B08_Sol_ATT_001_DRAFT_CDRL_W91CRB-19-R-5057.pdf

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Solicitation for Iraq FSR OCONUS_W91CRB19R5057
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W91CRB19R5057
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DRAFT Contract Data Requirements List (CDRL)

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CDRLs

CONTRACT DATA REQUIREMENTS LIST (CDRL)

(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 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:

A TDP TM OTHER MGMT

D. SYSTEM/ITEM

Communications and Electronics Equipment

E. CONTRACTOR/PR NO.

F. CONTRACTOR

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

A001 Operations Security (OPSEC) Anti-Terrorism Training Certificates

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

DI-MGMT-80934C SOW PARA. 2.5.1.1a AMSEL-LCS-CE

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

LT REQUIRED ASRQD BLK16

a. ADDRESSEE

b. COPIES

8. APP CODE

E

13. DATE OF SUBSEQUENT SUBMISSION

Draft Final

A ASRQD Reg Repro

16. REMARKS AMSEL-LCS-CE 1

1. BLK 9: The following statement shall be included on the deliverable:

DISTRIBUTION E. Distribution authorized to DoD Components only as this is a Sole Source contract. Date of determination is 21 May 14. Other requests for this document shall be referred to CECOM, ILSC, SAMD, APG, MD.

2. BLK 12: Submit an individual’s certificate within 30 calendar days after the employee and/or subcontractor personnel completes training. Multiple certificates may be submitted at one time.

3. BLK 13: The Government OPSEC Officer will review and approve within 30 days of submittal

15. TOTAL

▬▬▬▬► 1

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

23 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div, SAMD

J. DATE

23 January 2019

(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 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:

A TDP TM OTHER MGMT

D. SYSTEM/ITEM

Communications and Electronics

A002 Operations Security (OPSEC) iWatch Training Report

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

DI-MGMT-80934C SOW PARA. 2.5.1.1c AMSEL-LCS-CE

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

LT REQUIRED ASRQD BLK16

a. ADDRESSEE

b. COPIES

8. APP CODE

E

13. DATE OF SUBSEQUENT SUBMISSION

Draft Final

ASRQD Reg Repro

2. BLK 12: Submit initial iWatch report 30 days after contract award for review and approval by the Government OPSEC Officer

3. BLK 13: The Government OPSEC Officer will review and approve within 30 days of submittal

4. All submittals will be in electronic format (e-mail). All submittals shall be delivered to the addressees identified by the contracting officer.

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

23 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-MSD

Chief, CENTCOM Div, SAMD

j. DATE\

(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 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:

A TDP TM OTHER MGMT

D. SYSTEM/ITEM

Communications and Electronics

A003 Operations Security (OPSEC) OPSEC SOP

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

DI-MGMT-80934C SOW PARA. 2.5.1.2a AMSEL-LCS-CE

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

LT REQUIRED OTIME SEE BLK 16

a. ADDRESSEE

b. COPIES

8. APP CODE

E

13. DATE OF SUBSEQUENT

SUBMISSION Draft

Final

A Reg Repro

16. REMARKS AMSEL-LCS-CE 1

1. BLK 4: Prepare IAW DID 2.

3. BLK 9: The following statement shall be included on the deliverable:

DISTRIBUTION E. Distribution authorized to DoD Components only as this is a Sole Source contract. Date of determination is 21 May 14. Other requests for this document shall be referred to CECOM, ILSC, SAMD, APG, MD.

4. BLK 12: Submit SOP/Plan in electronic format NLT 90 days ADAD for review and approval by the Government OPSEC Officer. The Government OPSEC Officer will review and approve within 30 days of submittal of the

OPSEC SOP.

15. TOTAL ▬▬▬▬► 1

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

23 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div, SAMD

(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 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:

A TDP TM OTHER MGMT

D. SYSTEM/ITEM

Communications and Electronics

A004 Operations Security (OPSEC) Level I OPSEC Training Certificates

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

DI-MGMT-80934C SOW PARA. 2.5.1.2b AMSEL-LCS-CE

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

LT REQUIRED ASRQD BLK16

a. ADDRESSEE

b. COPIES

8. APP CODE

E

13. DATE OF SUBSEQUENT SUBMISSION

Draft Final

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

23 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div, SAMD

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 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:

A TDP TM OTHER MGMT

D. SYSTEM/ITEM

Communications and Electronics

A005 Operations Security (OPSEC) TARP Training Certificates

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

DI-MGMT-80934C SOW PARA. 2.5.1.2c AMSEL-LCS-CE

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

LT REQUIRED ASRQD BLK16

a. ADDRESSEE

b. COPIES

8. APP CODE

E

13. DATE OF SUBSEQUENT SUBMISSION

Draft Final

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

23 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div, SAMD

(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 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:

A TDP TM OTHER MGMT

D. SYSTEM/ITEM

Communications and Electronics

A006 Information Security (IS) DoD Cybersecurity Awareness Challenge Certificates

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

DI-MGMT-80934C SOW PARA. 2.5.2b AMSEL-LCS-CE

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

LT REQUIRED ASRQD BLK16

a. ADDRESSEE

b. COPIES

8. APP CODE

E

13. DATE OF SUBSEQUENT SUBMISSION

Draft Final

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

23 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div, SAMD

(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 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:

A TDP TM OTHER MGMT

D. SYSTEM/ITEM

Communications and Electronics

B001 Contract Summary Report Repair Report / Weekly Report

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

DI-MGMT-80447 SOW PARA. 5.2.1 / 5.2.2 AMSEL-LCS-CE

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

LT E ASRQD SEE BLK 16

a. ADDRESSEE

b. COPIES

8. APP CODE

13. DATE OF SUBSEQUENT SUBMISSION

Draft Final

16. REMARKS

AMSEL-LCS-CE 1

1. BLK 4: The Contractor shall prepare Repair Reports IAW the PWS and DI- MGMT-80447 guidelines.

2. BLK 12: The Contractor shall submit reports for each repair item within five (5) calendar days of completion of repair. The contractor shall submit weekly reports NLT two (2) working days at the close of the customer business week.

3. All submittals shall be by electronic transmittal (e-mail). All submittals shall be delivered to the addressees identified by the Contracting Officer’s Representative (COR).

4. The Government will review the report and provide any comments within 10 calendar days of receipt.

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

23 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div, SAMD

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 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:

A TDP TM OTHER MGMT

D. SYSTEM/ITEM

Communications and Electronics

B002 Contractor’s Progress, Status and Management Report Contract Status Report (CSR)

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

DI-MGMT-80227 SOW PARA. 5.2.3 AMSEL-LCS-CE

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

LT E MNTHLY SEE BLK 16

a. ADDRESSEE

Final

A MNTHLY Reg Repro

16. REMARKS

AMSEL-LCS-CE 1

1. BLK 4: The Contractor shall prepare monthly Contract Status Reports IAW the SOW and DI-MGMT-80227 guidelines

2. BLK 12: The Contractor shall submit the initial report within 30 calendar days after contract award

3. All submittals shall be by electronic transmittal (e-mail) and shall include DD FORM 250. All submittals shall be delivered to the addressees identified by the Contracting Officer’s Representative (COR).

4. The Government will review the report and provide any comments within 30 calendar days of receipt.

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

23 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div, SAMD

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 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:

C TDP TM OTHER MISC

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

Communications and Electronics Equipment

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

C001 Scientific and Technical Reports Certificate of Completion

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

DI-MISC-80711A SOW PARA. 5.2.4 AMSEL-LCS-CE

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

LT E SEE BLK

SEE BLK 16

a.

ADDRESSEE

Final

ASREQD Reg Repro

16. REMARKS AMSEL-LCS-

CE

1. BLK 4: Delete 10.2 of the DID and prepare IAW this CDRL and the SOW

2. BLK 12: Submit each certificate of completion along with each DD 250 as each CDRL requirement is completed

3. BLK 13: SUBMIT FINAL

The contractor shall provide a completed Certificate of Completion with each DD Form 250 for ALL CDRLs included in this SOW.

The information shall present data as described below:

a. As a minimum, the Contractor shall provide the following (see attached template in Appendix):

1) Contractor Information. Contract information, to include but not limited to:

a. Contract number

b. Delivery Order Number

c. Contract CLIN

d. FMS Case designator

e. Period/service being invoiced

f. Contractor Point of contact for certificate of completion to include, printed name, position/title/rank, phone number, email and signature certifying completion.

2) Identifying the person’s information that can verify that the services have been completed to include but not limited to:

Country/customer/US Government Personnel, point of contact for certificate of completion to include, printed name, position/title/rank, phone number, email address and signature verifying completion.

4. All submittals shall be by electronic transmittal (e-mail) and shall include DD Form 250.

All submittals shall be delivered to the addressees identified by the contracting officer.

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

23 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div, SAMD

Appendix A - Certificate of Completion Template

To be placed on Company letterhead.

Date:______________________ Subject:______________________________ Customer:________________________________ Contract Number:_____________________________ Delivery Order Number:___________________________ FMS Case Designator:_______________________ Contract CLIN:________________________________________________ Period and service invoiced:____________________________________________________ Include Class Roster:_____

Customer Comments:

Contractor Representative Customer Representative Printed Name:________________________ Printed Name:________________________ Title:________________________________ Title:________________________________ Date:________________________________ Date:________________________________

Signature Signature

(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 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:

E TDP TM OTHER MNGMT

D. SYSTEM/ITEM

Sexual Harassment/Assault Response and Prevention (SHARP)

E. CONTRACTOR/PR NO.

W91CRB-16-C-5009

D001 Report SHARP Policy

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

DI-MNGT-80368A PWS PARA. 6.1.1 AMSEL-LCS-CE

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

LT REQUIRED ASRQD BLK16

a. ADDRESSEE

b. COPIES

8. APP CODE

E

13. DATE OF SUBSEQUENT SUBMISSION

Draft Final

A N/A Reg Repro

16. REMARKS AMSEL-LCS-CE 1 1

1. BLK 9: The following statement shall be included on the deliverable:

“DISTRIBUTION E. Distribution authorized to DoD Components only as this is a Sole Source contract. Other requests for this document shall be referred to CECOM, ILSC, SAMD, APG, MD.”

2. BLK 12: Submission shall be 5 calendar days after contract award.

3. Report shall be in contractor format.

4. Submission shall be delivered in Microsoft Office 2013 suite of applications (MS Word, Excel, Power Point) by electronic transmittal (email) to the Contracting Officer’s Representative and accompanied by printed paper copy, if requested.

Alternate formats may be allowed subject to Government review and approval.

▬▬▬▬► 1 1

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

31 Jan 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div., SAMD

31 Jan 2019

PREVIOUS EDITION MAY BE USED Page 1 of 1 Pages

(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 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:

E TDP TM OTHER MNGMT

D. SYSTEM/ITEM

Sexual Harassment/Assault Response and Prevention (SHARP)

E. CONTRACTOR/PR NO.

W91CRB-16-C-5009

D002 Training Materials SHARP Training Materials

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

DI-ILSS-80872 PWS PARA. 6.1.1 AMSEL-LCS-CE

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

LT REQUIRED ASRQD BLK16

a. ADDRESSEE

b. COPIES

8. APP CODE

E

13. DATE OF SUBSEQUENT SUBMISSION

Draft Final

A N/A Reg Repro

16. REMARKS AMSEL-LCS-CE 1 1

1. BLK 9: The following statement shall be included on the deliverable:

“DISTRIBUTION E. Distribution authorized to DoD Components only as this is a Sole Source contract. Other requests for this document shall be referred to CECOM, ILSC, SAMD, APG, MD.”

2. BLK 12: Submission shall be 5 calendar days after contract award.

3. Report shall be in contractor format.

4. Submission shall be delivered in Microsoft Office 2013 suite of applications (MS Word, Excel, Power Point) by electronic transmittal (email) to the Contracting Officer’s Representative and accompanied by printed paper copy, if requested.

Alternate formats may be allowed subject to Government review and approval.

CUSTOMER 40

▬▬▬▬► 1 41

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

31 Jan 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div., SAMD

31 Jan 2019

PREVIOUS EDITION MAY BE USED Page 1 of 1 Pages

(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 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:

A TDP TM OTHER MGMT

D. SYSTEM/ITEM

Sexual Harassment/ Assault Response and Prevention (SHARP)

D003 Training Certificate SHARP Training Certificates

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

DI-MGMT-80934C SOW PARA. 2.5.2b AMSEL-LCS-CE

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

LT REQUIRED ASRQD BLK16

a. ADDRESSEE

b. COPIES

8. APP CODE

E

13. DATE OF SUBSEQUENT SUBMISSION

Draft Final

2. BLK 12: Submit an individual’s certificate within 5 calendar days after contract award. Multiple certificates may be submitted at one time.

3. BLK 13: The Contracting Officers Representative will review and approve within 5 days of submittal

G. PREPARED BY

Steven C. Cooper

AMSEL-LCS-CE

Engineer

H. DATE

31 January 2019

I. APPROVED BY

Wilma Solivan

AMSEL-LCS-CE

Chief, CENTCOM Div, SAMD

31 January 2019

CDRLs
Appendix A - Certificate of Completion Template

File details come from the government source that posted it.