08 DD Form 254_CERTIFIED PDF.pdf

CLASSIFICATION (When filled in): Unclassified PREVIOUS EDITION IS OBSOLETE. Page 1 of 6DD FORM 254, APR 2018

DEPARTMENT OF DEFENSE

CONTRACT SECURITY CLASSIFICATION SPECIFICATION

(The requirements of the National Industrial Security Program (NISP) apply to all security aspects of this effort involving classified information.)

OMB No. 0704-0567 OMB approval expires:

May 31, 2022

The public reporting burden for this collection of information, 0704-0567, is estimated to average 70 minutes 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, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. 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.

RETURN COMPLETED FORM AS DIRECTED IN THE INSTRUCTIONS.

1. CLEARANCE AND SAFEGUARDING

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED (See Instructions)

Top Secret

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

None (See instructions)

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.)

a. PRIME CONTRACT NUMBER (See instructions.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

HS002122BIFW0114

DUE DATE (YYYYMMDD)

3. THIS SPECIFICATION IS: (X and complete as applicable.)

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20220119

b. REVISED (Supersedes all previous specifications.)

REVISION NO. DATE (YYYYMMDD)

c. FINAL (Complete Item 5 in all cases.) DATE (YYYYMMDD)

4. IS THIS A FOLLOW-ON CONTRACT? No Yes If yes, complete the following:

Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract.

5. IS THIS A FINAL DD FORM 254? No Yes If yes, complete the following:

In response to the contractor's request dated , retention of the classified material is authorized for the period of:

6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code)

a. NAME, ADDRESS, AND ZIP CODE

TBD

b. CAGE CODE

TBD

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

TBD

7. SUBCONTRACTOR(S) (Click button if you choose to add or list the subcontractors -- but will still require a separate DD Form 254 issued by a prime contractor to each subcontractor)

a. NAME, ADDRESS, AND ZIP CODE

N/A

b. CAGE CODE

N/A

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

N/A

8. ACTUAL PERFORMANCE (Click button to add more locations.)

a. LOCATION(S) (For actual performance, see instructions.)

TBD

b. CAGE CODE (If applicable, see Instructions.)

TBD

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

TBD

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

PROVIDE INVESTIGATIVE FIELDWORK SERVICES IN SUPPORT OF THE MISSION OF THE DEFENSE

COUNTERINTELLIGENCE AND SECURITY AGENCY (DCSA).

DCSA BI Fieldwork 08 DD Form 254 CLASSIFICATION (When filled in): Unclassified

PREVIOUS EDITION IS OBSOLETE. Page 2 of 6DD FORM 254, APR 2018

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

b. RESTRICTED DATA

g. NORTH ATLANTIC TREATY ORGANIZATION

(NATO) INFORMATION

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.)

h. FOREIGN GOVERMENT INFORMATION

d. FORMERLY RESTRICTED DATA

i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

e. NATIONAL INTELLIGENCE INFORMATION:

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI) (See instructions.)

k. OTHER (Specify) (See instructions.)

11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL: (X all that apply. See instructions. Provide details in Blocks 13 or 14 as set forth in the instructions.)

a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT

ANOTHER CONTRACTOR'S FACILITY OR A GOVERNMENT

ACTIVITY

(Applicable only if there is no access or storage required at contractor facility.

See instructions.)

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE, STORE, AND GENERATE CLASSIFIED

INFORMATION OR MATERIAL

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE

e. PERFORM SERVICES ONLY

f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE

THE U.S.,PUERTO RICO, U.S. POSSESSIONS AND TRUST

TERRITORIES

g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE

TECHNICAL INFORMATION CENTER (DTIC) OR OTHER

SECONDARY DISTRIBUTION CENTER

h. REQUIRE A COMSEC ACCOUNT

i. HAVE A TEMPEST REQUIREMENT

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE

l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED

INFORMATION (CUI).

(DoD Components: refer to DoDI 5200.48, only for specific CUI protection requirements. Non-DoD Components: see instructions.)

m. OTHER (Specify) (See instructions.)

12. PUBLIC RELEASE

Any information (classified or unclassified) pertaining to this contract shall not be released for public dissemination except as provided by the National Industrial Security Program Operating Manual (NISPOM) or unless it has been approved for public release by appropriate U.S. Government authority.

Proposed public releases shall be submitted for review and approval prior to release to the appropriate government approval authority identified here with at least office and phone contact information and if available, an e-mail address. (See instructions)

DIRECT THROUGH (Specify below)

NO PUBLIC RELEASE IS AUTHORIZED

Public Release Authority:

DCSA OFFICE OF PUBLIC AFFAIRS, 27130 TELEGRAPH

ROAD, QUANTICO, VA 22134

13. SECURITY GUIDANCE

The security classification guidance for classified information needed for this effort is identified below. If any difficulty is encountered in applying this guidance or if any other contributing factor indicates a need for changes in this guidance, the contractor is authorized and encouraged to provide recommended changes; to challenge the guidance or the classification assigned to any information or material furnished or generated under this contract;

and to submit any questions for interpretation of this guidance to the official identified below. Pending final decision, the information involved shall be handled and protected at the highest level of classification assigned or recommended.

(Fill in as appropriate for the classified effort. Attach, or forward under separate correspondence, any documents/guides/extracts referenced herein. The field will expand as text is added. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted. Also allows for up to 6 internal reviewers to digitally sign. See instructions for additional guidance or use of the fillable PDF.)

• At the time of proposal submission and throughout the life of the contract (to include all potential option years), the Contractor shall possess and maintain a Top Secret facility clearance granted by the Defense Counterintelligence and Security Agency (DCSA). The Contractor’s employees, including subcontractors (if approved by the COR) and consultants (if permitted by the COR) performing work in support of this contract shall be US Persons; individuals performing on this contract shall possess and maintain a TOP SECRET clearance/ eligibility determination granted by the DoDCAF, based on a favorably adjudicated T5 or T5R; be within investigation scope and/or currently enrolled in Continuous Evaluation (CE) / Continuous Vetting (CV) at the time of contract award and throughout the life of the contract to include all potential option years identified in this PWS. All individuals supporting this contract shall have been granted a current Top Secret security clearance/eligibility. The DD254 will be completed within the Wide Area Workflow Business Suite, NISP Contracts Classification System (NCCS) when available. The DD254 will be housed within the NCCS through the life of the contract. In the event that the NCCS is sunset and subsequently superseded by another System Of Record, the same requirements apply. The DCSA KO will maintain the DD254 in the Official Contracts Records. It is incumbent upon the Contractor to ensure that the necessary security

PREVIOUS EDITION IS OBSOLETE. Page 3 of 6DD FORM 254, APR 2018 paperwork is submitted in sufficient time to enable each individual to be cleared prior to beginning work on this contract.

• Contractor personnel performing or assigned under this contract must be U.S. persons. Security Classification Guide requests should be presented to the Government Sponsor, if required, subsequent to contract award. All classified information received or generated under this contract is the property of the U. S. Government. The U. S. Government shall provide disposition instructions. No release of classified information or controlled unclassified information under this contract is authorized. All requirements for control and accounting of original documentation and copies apply. All applicable provisions of the NISPOM and its supplements and 32 CFR, part 117 apply. Any classified information shall be transmitted IAW DOD 5200.1-R, DOD Information Security Program Regulations. The contractor shall adhere to Chapter 8, NISPOM, which applies to non-DoD IT systems.

• Within 10 days of contract award, prime contractor shall submit a Visit Authorization Request (VAR) to DCSA Security Office to validate that all management, supervisory, and other personnel assigned to this contract meet the clearance. Failure to provide security eligibility information shall delay and/or deny the individual access to DCSA, and DoD facilities and information. It is the responsibility of the Prime Contractor to maintain either an owning or servicing relationship in DISS with all personnel supporting this contract, this includes Prime contractor personnel, subcontractor personnel, and any consultants. All Visit Authorization Requests (VARs) submitted to the host government locations must be sent via the Defense Industrial System for Security (DISS) and *must* come from the Prime Contractor's SMO in DISS. For visits to DCSA, Collateral Visit Authorization Requests should be sent to SMO DCSAHQSEC. Failure to provide security eligibility information shall delay and/or deny the individual access to DCSA, and DoD facilities and information.

• Contractor is not authorized to subcontract on this effort without an approved subcontracting plan with written GCA/COR authorization.

• All Common Access Cards (CACs), building access badges, and parking passes must be returned immediately at the end of the period of performance date or removal of individual from contract.

• The Contractor shall comply with (1) Security Agreement (DD Form 441/DD Form 441-1), including the National Industrial Security Program Operating Manual (NISPOM), DoD 5220.22-M and any revisions and (2) 32 CFR, Part 117.Provisions of the Privacy Act apply to all records and reports maintained by the contractors.

• All programs and materials developed at government expense during the performance period of this contract are the property of the US Government.

• Prior to granting an employee access to classified information and/or materials, the contractor shall brief employees with regard to their obligation to comply with the NISPOM, to include any changes and/or amendments, and 32 CFR, Part 117. The contractor’s employees shall be debriefed when access to the material is no longer needed or is terminated. A list of all employees who have had access to classified information during the period of this contract shall be maintained by the contractor company and be available for Defense Counterintelligence and Security Agency inspection.

• Access to General Protection/Security Policies and Procedures. All contractor employees, including subcontractor employees stationed or assigned on a US Government facility shall comply with applicable installation, facility access procedures and local security policies (provided by the US Government security personnel). The contractor workforce shall comply with all personal identification verification requirements as directed by DCSA and/or local policy. In addition to the changes otherwise authorized by the changes clause in this contract, should the Force Protection Condition (FPCON) at any individual facility or installation change, the US Government may require changes in the contractor security processes or procedures.

• Contractors requiring access to US Government Information Technology (IT) systems must adhere to all US Government requirements.

All contractor employees and any associated subcontractor employees shall annually complete the DoD Information Assurance Training and sign an Acceptable Use Policy (AUP). The training certificate and AUP must be provided to the designated personnel at US Government facilities before issuance of network access and annually thereafter.

• Contactor employees shall abide by US Government Security Regulations and Security Standard Operating Procedures when working on-site at US Government facilities/installations and shall annually attend Government mandatory training including Operational Security, Security Awareness, Subversion and Espionage, Ethics and Prevention of Sexual Harassment, and any/all other training as directed by the US Government.

• Common Access Cards (CACs) are authorized for contractor employees that work on-site at DCSA Government facility. CACs are the property of the US Government and shall be giving to the Contractor Facility Security Officer upon termination of employment with the company, expiration of the CAC, replacement of a CAC, or upon contract completion. The FSO shall immediately return the CACs to the DCSA Government Contracting Officer or Contracting Officer Representative. The loss of a CAC shall be reported on the first business day following the discovery of the lost CAC to your chain of command and to the issuing agency. Unauthorized possession of a CAC can be prosecuted criminally under section 701, title 18, United States Code. Photocopying of US Government Identification (CAC) is a

PREVIOUS EDITION IS OBSOLETE. Page 4 of 6DD FORM 254, APR 2018 violation of Title 18, US Code Part 1, Chapter 33, Section 01 and punishable by both fine and imprisonment. Although the asking for military/government identification is totally permissible by commercial establishments, there is a prohibition on duplication of government identification. A state issued driver license or other form of photo identification should be provided to be photocopied if an establishment insists on a photocopy of the traveler’s identification. Contractor is required to ensure that all employees are aware of this law.

• Contractor personnel shall utilize US Government or official company e-mail for transmitting official US Government business. Official US Government business shall NOT be transmitted via personal, private, and/or commercial e-mail accounts, i.e., YAHOO, HOTMAIL, GMAIL, JUNO, AOL, COMCAST, KNOLOGY, VERIZON, etc.

• Contractor is prohibited from using reference to this contract, classification, clearances, accesses (collateral and/or SCI), even by unclassified acronyms, in advertisements, websites, capabilities fliers, promotional efforts, or recruitment of employees.

The Period Of Performance is: TO BE DETERMINED

Ref 10j: Controlled Unclassified Information (CUI) / Receive, Store, or Generate Controlled Unclassified Information (CUI):

Contractor will be provided and will abide by DoD Regulation 5400.7, DoD Freedom of Information Act Program, and DoD 5200.01-M, Information Security Program. Guidance provided under separate cover. In accordance with DoD Instruction 5200.48 (DoDI 5200.48) dated March 6, 2020, Contractors are required to ensure all personnel receive and complete Initial and Annual Refresher CUI education and training and maintain documentation of this training for audit purposes. Initial and Annual Refresher CUI security education, training and awareness on the required topics identified in Section 2002:30 of Title 32 CFR, including protection and management of CUI, to DoD personnel and contractors through the Center for Development of Security Excellence (CDSE).

• CUI Courses and Resources Created for Industry:

•The Center for Development of Security Excellence (CDSE) has developed an eLearning course titled “DoD Controlled Unclassified Information (CUI) Training For Contractors (IF141.06.FY21.CTR). The course fulfills CUI training requirements for industry.

•Additionally, CDSE has a CUI Toolkit available at https://www.cdse.edu/toolkits/cui/current.html. The Toolkit includes training, policy documents, resources, and an FAQ video.

•Review the DoD CUI Registry at https://www.dodcui.mil to become familiar with CUI organizational index groupings and CUI categories.

Policy documents addressing CUI oversight:

•DoDI 5200.48 "Controlled Unclassified Information." (https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/520048p.PDF) •32 CFR 2002 Part IV National Archives and Records Administration 32 CFR Part 2002 “Controlled Unclassified Information” (https:// www.govinfo.gov/content/pkg/CFR-2017-title32-vol6/pdf/CFR-2017-title32-vol6-part2002.pdf) •E.O. 13556 Vol 75, No 216. “Controlled Unclassified Information” (https://www.govinfo.gov/content/pkg/FR-2010-11-09/ pdf/2010-28360.pdf) •NIST Special Publication 800-171 Rev. 2 “Protecting Controlled Unclassified Information in Nonfederal Systems and Organizations” (https://csrc.nist.gov/publications/detail/sp/800-171/rev-2/final

Ref 11a/e: TO BE DETERMINED

Ref 11j: OPERATIONS SECURITY (OPSEC) Requirements:

1. The contractor shall comply with OPSEC requirements contained in the contract, addendum thereto, or identified herein. The contractor will comply with all security and OPSEC policies, directives, instructions or mandates as directed. OPSEC and other security guidance issued to the Prime Contractor shall also apply to subcontractors working on this effort.

2. The contractor will ensure compliance with the Agency’s OPSEC Policy Statement, Critical Information List (CIL), and unclassified document destruction procedures. Items of critical information are those facts, which individually, or in the aggregate, reveal sensitive details about the mission, operation, etc., and thus require protection from adversarial collection or exploitation.

3. Include OPSEC as part of the security awareness program. The contractor shall be familiar with OPSEC and will be required to take government furnished initial and annual refresher OPSEC training and will be reminded of their continued responsibility to protect sensitive information as directed by DoDM 5205.02. Sensitive unclassified information includes, but is not limited to, agency identified critical information, legacy “For Official Use Only” (FOUO), Controlled Unclassified Information (CUI), Privacy Act of 1974, Personally Identifiable Information (PII), Department of Defense Unclassified Controlled Nuclear Information (DoD UCNI) and company proprietary information.

4. The contractor shall take the necessary precautions to ensure employees with access to the sensitive and critical information are instructed not to disclose or disseminate any information relating to the conduct and performance of the contract to any individual not authorized to perform on this contract. Assigned personnel shall be knowledgeable of the designated critical information and measures in place to protect it.

5. For programs protected by a Program Protection Plan (PPP) and have identified Critical Program Information (CPI) and/or Critical Technologies Information (CTI), must be identified and protected in accordance with DoD Instruction 5200.39, CPI Identification and Protection within RDT&E. The contractor shall ensure that any program with CPI or CTI has the corresponding supplements and

PREVIOUS EDITION IS OBSOLETE. Page 5 of 6DD FORM 254, APR 2018 associated plan, such as an OPSEC plan, approved and in effect in support of the PPP.

6. The contractor shall comply with OPSEC content review policies within the Agency. A content review is an evaluation of all information, to include all CUI, intended for release outside the control of the organization or release to the public. OPSEC focuses on identifying and protecting the organization’s unclassified information that may individually or in the aggregate lead to the compromise of classified information and sensitive activities. The contractor will ensure that these reviews are conducted according to agency guidance in accordance with mandates from DoDD 5205.02E, DoD OPSEC Program, DoDM 5205.02-M, DoD OPSEC Program Manual, DoDI 5230.09, Clearance of DoD Information for Public Release, DoDI 5230.29, Security and Policy Review of DoD Information for Public Release, DoDI 5400.04, Provision of Information to Congress, DoDM 5400.07, DoD FOIA Program, and DoDI 8170.01, Online Information Management and Electronic Messaging.

7. Further OPSEC guidance may be obtained by the Prime contractor contacting the OPSEC PM by group e-mail: dcsa.quantico.dcsa-hq.mbx.operations-security@mail.mil Ref 11l: Controlled Unclassified Information (CUI) / Receive, Store, or Generate Controlled Unclassified Information (CUI): Contractor will be provided and will abide by DoD Regulation 5400.7, DoD Freedom of Information Act Program, and DoD 5200.01-M, Information Security Program. Guidance provided under separate cover. In accordance with DoD Instruction 5200.48 (DoDI 5200.48) dated March 6, 2020, Contractors are required to ensure all personnel receive and complete Initial and Annual Refresher CUI education and training and maintain documentation of this training for audit purposes. Initial and Annual Refresher CUI security education, training and awareness on the required topics identified in Section 2002:30 of Title 32 CFR, including protection and management of CUI, to DoD personnel and contractors through the Center for Development of Security Excellence (CDSE).

• CUI Courses and Resources Created for Industry:

•The Center for Development of Security Excellence (CDSE) has developed an eLearning course titled “DoD Controlled Unclassified Information (CUI) Training For Contractors (IF141.06.FY21.CTR). The course fulfills CUI training requirements for industry.

•Additionally, CDSE has a CUI Toolkit available at https://www.cdse.edu/toolkits/cui/current.html. The Toolkit includes training, policy documents, resources, and an FAQ video.

•Review the DoD CUI Registry at https://www.dodcui.mil to become familiar with CUI organizational index groupings and CUI categories.

Policy documents addressing CUI oversight:

•DoDI 5200.48 "Controlled Unclassified Information." (https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/520048p.PDF) •32 CFR 2002 Part IV National Archives and Records Administration 32 CFR Part 2002 “Controlled Unclassified Information” (https:// www.govinfo.gov/content/pkg/CFR-2017-title32-vol6/pdf/CFR-2017-title32-vol6-part2002.pdf) •E.O. 13556 Vol 75, No 216. “Controlled Unclassified Information” (https://www.govinfo.gov/content/pkg/FR-2010-11-09/ pdf/2010-28360.pdf) •NIST Special Publication 800-171 Rev. 2 “Protecting Controlled Unclassified Information in Nonfederal Systems and Organizations” (https://csrc.nist.gov/publications/detail/sp/800-171/rev-2/final

Ref 12: Public Release:

NO PUBLIC RELEASE OF ANY INFORMATION PERTAINING TO THIS CONTRACT IS AUTHORIZED.. Except as otherwise specifically provided, any information made available to the Contractor by the Government will be used only for the purpose of carrying out the provisions of this Contract. It will not be divulged or made known in any manner to any persons, except as may be necessary in the performance of the Contract or other DCSA approved system. In performance of the Contract, the Contractor assumes responsibility for protection of the confidentiality of Government records and will ensure that its subcontractors will also protect the confidentiality of Government records. The Contractor will store and process all investigative information on the DCSA BIES. Each officer or Contractor personnel or any of its subcontractors with access to any Government record will be notified in writing by the Contractor that information disclosed to such officer or employee can only be used for the purpose and to the extent authorized by the Contract. Further disclosure of any such information, by any means, for a purpose or to an extent unauthorized by the Contract, may be subject to criminal sanctions under 18 U.S.C. 641. That section of the criminal code of the United States provides that whoever knowingly converts to their own use or the use of another, or without authority, sells, conveys, or disposes of any record of the United States or whoever receives the same with the intent to convert it to their use or gain, knowing it to have been converted, will be guilty of a crime punishable by a fine of up to $10,000.00, or imprisonment of up to ten years or both.

List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form)

NAME & TITLE OF REVIEWING OFFICIAL

Frank J. Argenziano, Contracting Officer Acquisition & Contracting, DCSA

SIGNATURE

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, are established for this contract.

No Yes

ARGENZIANO.FRA

NK.JON.1461292760

Digitally signed by

ARGENZIANO.FRANK.JON.14

61292760 Date: 2022.02.08 14:57:10 -05'00'

PREVIOUS EDITION IS OBSOLETE. Page 6 of 6DD FORM 254, APR 2018

If Yes, identify the pertinent contractual clauses in the contract document itself, or provide an appropriate statement which identifies the additional requirements. Provide a copy of the requirements to the CSO. The field will expand as text is added or you can also use item 13. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted.

(See instructions for additional guidance or use of the fillable PDF.)

15. INSPECTIONS

Elements of this contract are outside the inspection responsibility of the CSO.

No Yes If Yes, explain and identify specific areas and government activity responsible for inspections. The field will expand as text is added or you can also use item

13. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted.

(See instructions for additional guidance or use of the fillable PDF.)

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)

a. GCA NAME

DCSA OFFICE OF ACQUISITIONS

b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)

HS0021

c. ADDRESS (Include ZIP Code)

27130 TELEGRAPH ROAD

QUANTICO, VA 22134

d. POC NAME

Mr. Frank J. Argenziano

e. POC TELEPHONE (Include Area Code)

+1 (703) 826-5952

f. EMAIL ADDRESS (See Instructions) frank.j.argenziano.civ@mail.mil

17. CERTIFICATION AND SIGNATURES

Security requirements stated herein are complete and adequate for safeguarding the classified information to be released or generated under this classified effort. All questions shall be referred to the official named below. Upon digitally signing Item 17h, no changes can be made as the form will be locked.

a. TYPED NAME OF CERTIFYING OFFICIAL (Last, First, Middle Initial) (See Instructions)

PETERS-CARR, CARLA, S.

b. TITLE

DCSA INDUSTRIAL SECURITY PROGRAM MANAGER

c. ADDRESS (Include ZIP Code)

HQ DEFENSE COUNTERINTELLIGENCE & SECURITY

AGENCY (HQ-DCSA)

27130 TELEGRAPH ROAD, QUANTICO, VA 22134

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

HS0001

e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.)

f. TELEPHONE (Include Area Code)

+1 (571) 305-6648

g. EMAIL ADDRESS (See Instructions) carla.s.peters-carr.civ@mail.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

20220209

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

a. CONTRACTOR

b. SUBCONTRACTOR

c. COGNIZANT SECURITY OFFICE FOR PRIME AND

SUBCONTRACTOR

d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY

ADMINISTRATION

e. ADMINISTRATIVE CONTRACTING OFFICER

f. OTHER AS NECESSARY (If more room is needed, continue in Item 13 or on additional page if necessary.)

jason.benitez.civ@mail.mil clark.w.dates.civ@mail.mil julia.m.stiglitz.civ@mail.mil

PETERS-

CARR.CA

RLA.SUE.1

268996962

Digitally signed by PETERS-

CARR.CARLA.

SUE.126899696

Date: 2022.02.09 10:36:21 -05'00'