22R5434 Attachment IX (H) - DD Form 254.pdf

CLASSIFICATION (When filled in): Unclassified

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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:

June 30, 2025

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.)

N3220522R5434

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20230201

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 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)

a. NAME, ADDRESS, AND ZIP CODE

INDOPACOM AOR

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.)

a. LOCATION(S) (For actual performance, see instructions.) b. CAGE CODE (If applicable, see Instructions.)

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

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

One clean, approved upon delivery U.S. Flag, double hull tanker with an Inert Gas System (IGS) and Segregated Ballast Tanks (SBTs) that is capable of carrying a minimum of 310,000 BBLS of clean petroleum products (intention JP8, JP5, F76) within the vessel’s natural segregation in designated cargo tanks with double valve isolation.The Contractor shall provide a secure space on-board the ship that can meet the specified by DoD 5220.22-M.

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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)

Military Sealift Command Office of Public Affairs

Public Release Authority:

Military Sealift Command Office of Public Affairs

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.)

A. The Contractor shall be responsible for Controlled Cryptographic Instruments (CCI), such as a STE telephone, issued by the MSC Operational or Administrative Commander. The Contractor shall provide a secure space on-board the ships identified in Block 9 for use of CCI equipment and shall designate accountable personnel as specified by DoD 5220.22-M, National Industrial Security Program Operating Manual (NISPOM). The Contractor may also be issued COMSEC keying material which requires that two-person integrity (TPI) be maintained on board the ship as specified in DoD 5220.22-M NISPOM Supplement 1. Any two ship's officers who hold a SECRET clearance granted by DISCO are acceptable as COMSEC keying material users. Physical safeguards for all classified material shall be provided by Contractor personnel as specified in DoD 5220.22-M.

B. Information Security Requirements(InfoSec). The Contractor shall handle, store, and maintain classified material in compliance with requirements set by DOD 5220.22(series), National Industrial Security Program Operating Manual, and the DD Form 254, DOD Contracts Security Classification Specification for classified contracts. All members who require access to classified information, sensitive information, controlled unclassified information (to include Privacy Act and Personally Identifiable Information (PII) or access to the classified information network shall comply with DoD Manual 5200.01 Vol I - IV (DoD Information Security Program), SECNAV

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M5510.36 (SECNAV Information Security Program), and DoDD 5240.06 (Counterintelligence Awareness and Reporting - CIAR). The Contractor shall implement InfoSec measures for its contractor furnished unclassified information technology system(s) used in performance of this contract. InfoSec measures shall be compliant with DFARS 252.204-7012, Safeguarding Covered Defense Information and Cyber Incident Reporting. At a minimum, the security standards extracted from the referenced National Institute of Standards and Technology (NIST) Special Publication 800-171, Protecting Controlled Unclassified Information in Nonfederal Information Systems and Organizations or accepted equivalents, shall be incorporated into any InfoSec program the contractor establishes.

C. The Contractor shall be responsible for the storage requirements. See DoD 5220.22-M National Industrial Security Operating Manual (NISPOM) for industrial security guidance, SECNAV M-5510.30 Personnel Security Program for personnel security guidance, and SECNAV M-5510.36 Information Security Program, for information security guidance and guidance on handling FOUO. All classified documents, when no longer needed, shall be destroyed as classified waste in accordance with DoD 5220.M and SECNAV 5510.36.

D. Contract performance requires that designated personnel employed onboard the ship have access to SECRET information regarding the operational employment and safe navigation of the ship. The Contractor shall ensure that any classified information disclosed to its employees is not further released or made available to other employees, or any other person who does not have a comparable clearance and a "Need to Know.

E. The Contractor shall provide annually to the COR, an updated list of all crew members who are designated to have access to classified information.

F. This form must be modified to include subcontractor information, if they are used. The contractor will ensure all subcontractors follow security guidance.

G. See Section C 1.6.12 Operational Security (OPSEC) in the PWS for OPSEC requirements and additional details.

H. Contractor shall provide a Visit Authorization Letter (VAL) listing for all contract personnel located on the installation(s) and on-board the ship(s) that require or will have access to classified information. Contractor shall provide a VAL listing for the other contractors that perform contractual services on the installation(s) or on-board ship(s) that require or will have access to sensitive unclassified information, which includes the other contractors that require routine or frequent "entry" to the installation(s) or on-board the ship(s) in the performance of other types of contracts, services or maintenance. During the performance period of the contract, the Facility Security Officer, shall notify Command Security Manager within 7 working days of any changes to the VAL listing of the contractor personnel.

I. Specific key billets as specified in the contract shall have access to Secret information regarding mission operation employment must be US citizens and possess at least a Secret clearance. All designated personnel who maintain a security clearance and handle classified information must attend Counterintelligence Awareness and Reporting (CIAR) Training. See DoD Directive Number 5240.06 for guidance.

J: All Controlled Unclassified Information (CUI) associated with this contract must be protected per the guidance provided for Item 11(l) of this DD Form 254 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

Eric C. Schotter

SIGNATURE

14. ADDITIONAL SECURITY REQUIREMENTS

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

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.)

Personnel shall have OPSEC requirements that flow down from the prime contract, Section C-2.6.6. All vessel personnel are required to complete OPSEC awareness on an annual basis: https://securityawareness.usalearning.gov/opsec/index.htm.

IAW DoD 5220.22-M, National Industrial Security Operating Manual (NISPOM) all contracting marine personnel who have access to classified information must comply with DoD Directive 5240.06 Counterintelligence Awareness and Reporting and will complete training located at https://www.cdse.edu/Training/eLearning/CI112/.

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.)

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

a. GCA NAME

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

c. ADDRESS (Include ZIP Code) d. POC NAME

e. POC TELEPHONE (Include Area Code)

f. EMAIL ADDRESS (See Instructions)

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)

Schotter Eric C

b. TITLE

Security Director

c. ADDRESS (Include ZIP Code)

Naval Station Norfolk 471 East C Street, Bldg. SP-47 Norfolk, VA 23511-2419

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

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

f. TELEPHONE (Include Area Code)

+1 (757) 443-2872

g. EMAIL ADDRESS (See Instructions) eric.c.schotter.civ@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.)