Exhibit A

CONTRACT DATA REQUIREMENT LIST – DD Form 1423

Form Approval OMB No. 0704-0188
Public reporting burden for this collection of information is estimated to average 440 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 this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.: 0001

B. EXHIBIT A

C. CATEGORY

D. SYSTEM/ITEM

E. CONTRACT/PR NO.:

F. CONTRACTOR

1. DATA ITEM NO: A001

2. TITLE OF DATA ITEM: Test/Inspection Report
3. SUBTITLE: Inspection Records – First Article Sample WVA FORM 702-61-R-E, 16 March 2016 702-CQD-E

61 8 Jan 2025(CN 3)

4. AUTHORITY: DI-NDTI-80809B

5. CONTRACT REFERENCE: First Article Clause

6. REQUIRING OFFICE: TAWV-CQD-C CQD-E

7. DD250 REQUIRED: *See Block 16

8. APP CODE:

9. DISTRIBUTION STATEMENT REQUIRED: B Test and Evaluation

10. FREQUENCY: ONE/P

11. AS OF DATE:

12. DATE OF FIRST SUBMISSION: With First Article
13. DATE OF SUBSEQUENT SUBMISSIONS: With First Article

14. DISTRIBUTION:

A. ADDRESSEES: As specified in contract or purchase order

B. COPIES:

DRAFT: 0

FINAL: 1

15. TOTAL: 1

16. REMARKS: Delete paragraph 10.2 of referenced DID (Block 4). Submit WVA Form 702-61-R-E showing results of inspections. Also submit DD Form 1222. Computerized versions of these forms may be used with prior approval of the procuring office. See QAP-APPX-WVA paragraph 10 for requirements. * Inspection/acceptance requirements specified in the contract. Data Item Description (DID) referenced in block 4 can be accessed at: http//assist.daps.mil.

17. PRICE GROUP:

18. ESTIMATED TOTAL PRICE:

G. PREPARED BY: J Cannon

H. DATE: 3 Mar 2025

I. APPROVED BY: William Potter, TAWV-CQD-E

J. DATE: 3 March 2025

CONTRACT DATA REQUIREMENT LIST – DD Form 1423

Form Approval OMB No. 0704-0188
Public reporting burden for this collection of information is estimated to average 440 hours per response, including