2.04c N0060426Q4096_Att (3) - DD254.pdf

CLASSIFICATION (When filled in): Unclassified

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AEM LiveCycle Designer DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE. Page 1 of 4

AEM LiveCycle Designer

DD 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:

October 31, 2020

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)

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

TBD

DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20260712

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 - Pre-Award

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

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) Add Row Remove last Row Delete All Rows

a. NAME, ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

8. ACTUAL PERFORMANCE (Click button to add more locations.) Add Row Remove last Row Delete All Rows

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

EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

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

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

EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

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

EOD Mobile Unit ONE 140 Sylvester Road, Naval Base Point Loma, San Diego, CA 92106

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

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

EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

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DD FORM 254, APR 2018

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

EOD Mobile Unit THREE 2930 Tarawa Road, Naval Base Coronado, San Diego, CA 92155-5198

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

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

EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

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

EOD Mobile Unit NINE 3502 Attu Road, BLDG 104, Naval Base Coronado, San Diego, CA 92155-5589

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

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

EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

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

EOD Mobile Unit ELEVEN 1498 13th Street, NOLF IB BLDG 193, Imperial Beach, CA 91932-3798

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

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

EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

The objective of this contract is to obtain dedicated equipment readiness and comprehensive logistics support services to maximize the operational capability and lifecycle sustainment of Explosive Ordnance Disposal Group ONE (EODGRU ONE) forces TOA equipment and material. Contractor support will be required to access various software equipment readiness, inventory, and reporting systems some of which are maintained within SIPRNet.

Equipment Readiness Coordination: Analyze equipment readiness (E-Piller) utilizing Enterprise Logistics Management System (ELMS) subject matter expertise to perform analytical support, tracking, health assessment, and reporting of EOD and TOA equipment within respective commands to inform leadership on readiness gaps and resource allocation.

Logistics Support: Hands-on supply chain management, including inventory management, warehousing, issue and receipt, and maintenance tracking of EOD and TOA gear. Additionally, assist commands with receipt, tracking, shipping, and delivery, as well as management of all command equipment requiring calibration, repairs and disposition.

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.)

SIPRNet (See Item 13)

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.)

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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 DoDM 5200.01, Volume 4 only for specific CUI protection requirements. Non-DoD Components: see instructions.)

m. OTHER (Specify) (See instructions.)

Performance restricted to Government-controlled facilities specified in Block 8 (See item 13).

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) Public Release Authority:

EODGRU ONE PAO, 704-779-9257

13. SECURITY GUIDANCE Add Signature Remove last Signature Delete All Signatures

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.)

Ref Block 10e(2), and 10k (SIPRNet): Contractor personnel will require access to SECRET National Security Information and the Secure Internet Protocol Router Network (SIPRNet) to perform daily duties.

Ref Block 10j & 11j (CUI): Contractor will have access to and generate Controlled Unclassified Information (CUI). CUI shall be handled, marked, and safeguarded in accordance with DoDI 5200.48.

Ref Block 11a & 11m (Performance Locations): All work under this contract must be performed exclusively on-site at EOD Group ONE and subordinate EOD Mobile Units (EODMUs) as detailed in Block 8. No classified material, CUI, or government IT equipment may be removed from these government-controlled workspaces.

Security Policies: While on-site, contractors must strictly adhere to all local installation physical security instructions, Command Security Manager (CSM) policies, and command Information Assurance (IA) protocols.

IT Systems Access: Prior to SIPRNet/NIPRNet account creation, contractor personnel must complete mandatory DoD Cyber Awareness training and possess a verified SECRET clearance in the defense system of record (DISS).

Classification Guidance: Classified information generated under this contract shall be marked and safeguarded in accordance with the applicable EOD Security Classification Guides (SCGs), which will be provided locally by the EODGRU ONE CSM upon contract initiation.

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

Add Attachment View Selected Attachment Remove Selected Attachment

NAME & TITLE OF REVIEWING OFFICIAL

SAMUEL RIVET, SSO

SIGNATURE

14. ADDITIONAL SECURITY REQUIREMENTS

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

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AEM LiveCycle Designer

DD FORM 254, APR 2018

No Yes 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

NAVSUP FLC Pearl Harbor

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

N00604

c. ADDRESS (Include ZIP Code)

NAVSUP FLT LOG CTR PEARL

HARBOR

SUITE 100, 1942 GAFFNEY STREET

PEARL HARBOR, HI 96860-4549

d. POC NAME

Bazard, Kristina

e. POC TELEPHONE (Include Area Code)

+1 (808) 602-1316

f. EMAIL ADDRESS (See Instructions) kristina.n.bazard.civ@us.navy.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)

Rivet, Samuel, A

b. TITLE

Special Security Officer

c. ADDRESS (Include ZIP Code) 2424 Rendova Road, BLDG 156, San Diego, CA, 92155

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

N00604

e. CAGE CODE OF THE PRIME CONTRACTOR

(See Instructions.)

f. TELEPHONE (Include Area Code)

+1 (619) 437-3318

g. EMAIL ADDRESS (See Instructions) samuel.a.rivet.mil@us.navy.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

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.)

DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of AEM LiveCycle Designer

DD FORM 254, APR 2018

NEEDS DD67

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:

October 31, 2020 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

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

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

a. ORIGINAL (Complete date in all cases.)

b. REVISED (Supersedes all previous specifications.)

4. IS THIS A FOLLOW-ON CONTRACT?

If yes, complete the following:

Classified material received or generated under

5. IS THIS A FINAL DD FORM 254?

If yes, complete the following:

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

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)

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

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

e. NATIONAL INTELLIGENCE INFORMATION:

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.)

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)

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.)

14. ADDITIONAL SECURITY REQUIREMENTS

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

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.

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)

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.

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

9.0.0.2.20120627.2.874785 DD 254, DoD Contract Security Classification Specification List of Attachments (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form)

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

CSO: EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

CSO: EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

CSO: EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

CSO: EODGRU ONE

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400

2424 Rendova Road, BLD 156, Naval Base Coronado, San Diego, CA 92155-5400 Location: EOD Mobile Unit ONE 140 Sylvester Road, Naval Base Point Loma, San Diego, CA 92106 Location: EOD Mobile Unit THREE 2930 Tarawa Road, Naval Base Coronado, San Diego, CA 92155-5198 Location: EOD Mobile Unit NINE 3502 Attu Road, BLDG 104, Naval Base Coronado, San Diego, CA 92155-5589 Location: EOD Mobile Unit ELEVEN 1498 13th Street, NOLF IB BLDG 193, Imperial Beach, CA 91932-3798 Block9: The objective of this contract is to obtain dedicated equipment readiness and comprehensive logistics support services to maximize the operational capability and lifecycle sustainment of Explosive Ordnance Disposal Group ONE (EODGRU ONE) forces TOA equipment and material. Contractor support will be required to access various software equipment readiness, inventory, and reporting systems some of which are maintained within SIPRNet.

Equipment Readiness Coordination: Analyze equipment readiness (E-Piller) utilizing Enterprise Logistics Management System (ELMS) subject matter expertise to perform analytical support, tracking, health assessment, and reporting of EOD and TOA equipment within respective commands to inform leadership on readiness gaps and resource allocation.

Logistics Support: Hands-on supply chain management, including inventory management, warehousing, issue and receipt, and maintenance tracking of EOD and TOA gear. Additionally, assist commands with receipt, tracking, shipping, and delivery, as well as management of all command equipment requiring calibration, repairs and disposition.

Ref Block 10j & 11j (CUI): Contractor will have access to and generate Controlled Unclassified Information (CUI). CUI shall be handled, marked, and safeguarded in accordance with DoDI 5200.48.

Ref Block 11a & 11m (Performance Locations): All work under this contract must be performed exclusively on-site at EOD Group ONE and subordinate EOD Mobile Units (EODMUs) as detailed in Block 8. No classified material, CUI, or government IT equipment may be removed from these government-controlled workspaces.

Security Policies: While on-site, contractors must strictly adhere to all local installation physical security instructions, Command Security Manager (CSM) policies, and command Information Assurance (IA) protocols.

IT Systems Access: Prior to SIPRNet/NIPRNet account creation, contractor personnel must complete mandatory DoD Cyber Awareness training and possess a verified SECRET clearance in the defense system of record (DISS).

Classification Guidance: Classified information generated under this contract shall be marked and safeguarded in accordance with the applicable EOD Security Classification Guides (SCGs), which will be provided locally by the EODGRU ONE CSM upon contract initiation.

SUITE 100, 1942 GAFFNEY STREET

PEARL HARBOR, HI 96860-4549

Address: 2424 Rendova Road, BLDG 156, San Diego, CA, 92155