81933 - Contract Data Requirements List A003 - Calibration Certificate

CONTRACT DATA REQUIREMENTS LIST

Form Approved

OMB No. 0704-0188

(1 Data Item)

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

0002

C. CATEGORY:

A

D. SYSTEM/ITEM

E. CONTRACT/PR NO.

F. CONTRACTOR

Creaform HandySCAN EVO Elite
1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM

3. SUBTITLE

Calibration Certificate

N/A

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE

DI-QCIC-80798C/T

7. DD 250 REQ

NO

9. DIST STATEMENT

REQUIRED

8. APP CODE

N/A

A

17. PRICE GROUP

10. FREQUENCY

12. DATE OF FIRST SUBMISSION

ASREQ

402 MXSG

14.

DISTRIBUTION

ASREQ

11. AS OF DATE

SEE BLK 16

18. ESTIMATED

TOTAL PRICE

6. REQUIRING OFFICE

PD Para 2.3

13. DATE OF SUBSEQUENT

SUBMISSION

b. COPIES

a. ADDRESSEE

16. REMARKS

Final

Draft

SEE BLK 16

See blk 16

Reg

Repro

Within five (5) days after completion of the calibration and preventive maintenance, the Contractor shall electronically send the CDRLs as PDFs to the Government POC. Government POC: Stephen Tew, [email protected]
WAWF Primary POC: Kelsey Jackson, [email protected] WAWF Alternate POC: Dustin Knowles, [email protected] Contracting Officer: Nikia Streeter, [email protected] Alt Contracting Officer: Andrew Harth, [email protected]

15. TOTAL

G. PREPARED BY

H. DATE

Latreva S. Schoultz

SCHOULTZ.LATREVA.SHENEL

L.1257109158

Digitally signed by

SCHOULTZ.LATREVA.SHENELL.1257109158

Date: 2026.09.18 13:40:00 -04'00'

DD FORM 1423-1, FEB 2001

9/18/2026

I. APPROVED BY

J. DATE

Latreva S. Schoultz

9/18/2026

signed by

SCHOULTZ.LATREVA.SHE Digitally

SCHOULTZ.LATREVA.SHENELL.1257109158

Date: 2026.09.18 13:40:31 -04'00'

NELL.1257109158

PREVIOUS EDITION MAY BE USED.

Page

of