Contract Data Requirements List A003 - Contractors Safety Plan

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

000X

C. CATEGORY:

A

D. SYSTEM/ITEM

E. CONTRACT/PR NO.

F. CONTRACTOR

B670 Paint Booth HVAC
1. DATA ITEM NO.

A003

3. SUBTITLE

Test/Inspection Report

Acceptance Test Report

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE

DI-NDTI-80809B

7. DD 250 REQ

NO

17. PRICE GROUP

2. TITLE OF DATA ITEM

9. DIST STATEMENT

REQUIRED

8. APP CODE

N/A

A

10. FREQUENCY

12. DATE OF FIRST SUBMISSION

See Blk 16

11. AS OF DATE

See Blk 16

18. ESTIMATED

TOTAL PRICE

6. REQUIRING OFFICE

PD Para 1.1.10

WR-ALC/402 CMXG

14.

DISTRIBUTION

See Blk 16

13. DATE OF SUBSEQUENT

SUBMISSION

b. COPIES

a. ADDRESSEE

16. REMARKS

Final

Draft

See Blk 16

Reg

Repro

SEE BLOCK 16

Acceptance. After the 100-ton HVAC system and side access door have been installed, the Contractor shall conduct a functional test of the system to ensure proper operation whereas all features are operating properly according to specifications which shall include a visual inspection and operational test.
The Contractor shall provide the test data for acceptance via electronically (email) to the Government Representative(s) three days after the acceptance. Government POC:
Primary: Emily Johns, 478-222-5260, [email protected] Alternate: Kristyn Edmondson, 478-926-5752, [email protected] WAWF Primary POC: Lisa Matney, 478-926-0634, [email protected] WAWF Alternate POC: Joseph Santillan, 478-926-2829, [email protected] Contracting POC:
Jeffrey Pruitt, 478-222-1491, [email protected]

15. TOTAL

G. PREPARED BY

MATNEY.LISA.D.1229956287