25R0002 - Attachment IX(H) - DD Form 254.pdf

CLASSIFICATION (When filled in): CUI

PREVIOUS EDITION IS OBSOLETE. Page 1 of 5DD 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:

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.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

N3220523R4017

DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

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 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 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.)

On-board vessel MT "TBD"

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 270,000 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 requirements specified by DoD 5220.22-M.

PREVIOUS EDITION IS OBSOLETE. Page 2 of 5DD 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.)

10(k): See Item 13, and Item 14.

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) Public Release Authority:

Military Sealift Command, Public Affairs Office, Code N02P 471 East C Street., Norfolk VA 23511-2419

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.)

Item 1(a)/1(b): This clause applies to the extent that this contract involves access to information classified "Confidential" or "Secret". The Contractor shall comply with - The Security Agreement DD Form 441, including Part 117 of Title 32 CFR; and any revisions to that manual, notice of which has been provided to the Contractor. If, subsequent to the date of this contract, the security classification or security requirements under this contract are changed by the Government and if the changes cause an increase or decrease in security costs or otherwise affect any other term or condition of this contract, the contract shall be subject to an equitable adjustment as if the changes were directed under the Changes clause of this contract. The Contractor agrees to insert terms that conform substantially to the language of this clause, including this paragraph but excluding any reference to the Changes clause of this contract, in all subcontracts under this contract that involve access to classified information.

Item 8(a): Actual performance locations of classified work will only be performed on-board vessel MT "TBD"

Item 10(a): COMSEC information/material will be processed in compliance with Part 117 and 117.21 of Title 32 CFR, OPNAVINST 2221.5D (Release of Communications Security Material to U.S. Industrial Firms Under Contract to the Department of the Navy (15 Aug

PREVIOUS EDITION IS OBSOLETE. Page 3 of 5DD FORM 254, APR 2018

2016)), DODI and DODM 5220.01 Vol I-III (DOD Information Security Program), in the control and protection of COMSEC material and information, and any additional security guidelines. Contractor personnel requiring COMSEC access must be U.S. Citizens and possess a final clearance at the appropriate level. All contractors shall be briefed before access to COMSEC is granted U.S. cryptographic equipment inventory information and the systems and applications used are for official use only. Publication, disclosure, or other release of COMSEC related information by any means by a contracting entity without prior written approval of the contracting office is prohibited. IAW 32 CFR 117.21(h), subcontracts requiring the disclosure of classified COMSEC information will be awarded only upon the written approval of the GCA. Contractor personnel granted access to classified COMSEC material must hold a final personnel security clearance appropriate for the COMSEC material accessed. Clearances for facility security officers, COMSEC custodians, and alternate COMSEC custodians having access to top secret keying material marked as containing cryptographic information must have a final security clearance based upon a single scope background investigation current within 5 years. All contractor personnel with access to COMSEC material must be briefed annually regarding the unique nature of COMSEC material and their responsibilities for safeguarding and controlling the material.

Contractor personnel who perform maintenance on U.S. Government cryptographic equipment or CCI must satisfy and comply with the provisions of CNSSI 4000, Maintenance of Communications Security Equipment, 12 Oct 2012 (NOTAL). IAW DODM 8140.03, contractor personnel, whose duties require privileged access to a government computer system, including those used for COMSEC management purposes must be trained and certified IAW DODI 8140.02.

Item 10(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.

Item 10(k): Only those billets specifically assigned as users of secure communications, as Privileged Users; either Principal Authority, Local Element Manager, or alternate Local Element Manager listed in section "Secure Communications" of contract number TBD performance work statement, will require SECRET eligibility and must be by U.S. citizens. All designated personnel who maintain a security clearance and handle classified information must attend Counterintelligence Awareness and Reporting (CIAR) training. See DoDD 5240.06, Counterintelligence Awareness and Reporting, for guidance. The Contractor shall ensure that any classified information disclosed to its employees is no further released or made available to other employees, or any other person who does not have a comparable clearance and a "Need to know". The MSC Administrative or Operational Commander designated for the contract will be responsible for releasing classified information to the contractor’s shipboard personnel and will provide the Master with the applicable Security Classification Guide

(SCG).

Item 10(k) continued: In performance of this contract, contractors shall follow security guidance IAW Part 117 of Title 32 CFR (NISPOM) for industrial security guidance, SECNAVINST 5510.30, Personnel Security Program for personnel security guidance, DODM 5200.01 Vol I-III Information Security Program, for information security guidance and handling of CUI. All classified documents, when no longer needed, shall be destroyed as classified waste in accordance with Part 117 of Title 32 CFR, and DODM 5200.01 Vol I-III.

Item 10(k) continued: The Contractor performing duties under this contract must adhere to all service/component command/local security directives, regulations and standard operating procedures at all contract performance locations.

Item 11(c): The contractor requires access to classified source data up to and including the level identified in item 1a of this document (DD Form 254). Classified material generated in support of this contract shall be classified in accordance with the source material of the Security Classification Guidance, which will be provided by the GCA. Automated Information Systems (AIS) must be certified and accredited by the Cognizant Security Agency (CSA) prior to processing classified information associated with this contract.

Item 11(c) continued: All contractors with access to classified information systems are required to receive the NATO briefing and responsibilities for safeguarding NATO classified information, and acknowledge receipt of the brief in writing.

Item 11(c) continued: All personnel 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-III, and DoDD 5240.06.

Item 11(c) continued: The Contractor shall handle, store, and maintain classified material in compliance with requirements set by Part 117 and 117.15 of Title 32 CFR, and this document DD Form 254.

Item 11(h): Contractor will contact Military Sealift Command (MSC) COMSEC Vault for account procedures, IAW COMSCINST 2280.3 (series) (Communications Policy and Procedures for Handling, Distribution, and Control of Communications Security Material within Military Sealift Command), MSC QMS Procedure N6.62-5239-1-Q (System Authorization Access Request Navy Procedures), COMSCINST 5239.3C (MSC Cyber Security Policy), MSC N6.N62-5239-3-Q (MSC Cyber Security Manual), and as specified in the Performance Work Statement (PWS) All equipment will be furnished by MSC, and maintained by the contractor IAW requirements in DODI 8523.01 (Communications Security), and guidance provided by the Contracting Officer and/or Contracting Officer Representative.

Item 11(j): The Contractor shall utilize the Military Sealift Commands' Critical Information and Indicators List, which will be identified or

PREVIOUS EDITION IS OBSOLETE. Page 4 of 5DD FORM 254, APR 2018 provided by the Contracting Officer or Contracting Officer Representative to help identify and protect critical information associated with this contract. During the period of this contract, the Contractor may be exposed to, use, or produce, MSC Critical Information (CI) and/or observables and indicators which may lead to discovery of CI. MSC's CI will not be distributed to unauthorized third parties, including foreign governments, or companies under Foreign Ownership, Control, or Influence (FOCI). MSC’s CI shall not be publicized in corporate wide newsletters, trade magazines, displays, intranet pages or public facing websites. Media requests related to this project shall be directed to MSC Public Release Authority listed in Item 12 of this DD Form 254. Any attempt by unauthorized third parties to solicit, obtain, photograph, or record, or; incidents of loss/compromise of government Classified or CI, Business Sensitive and Company Proprietary information related to this contract or other programs must be immediately reported to the Facility Security Officer, DCSA and/or the Naval Criminal Investigative Service. Performance under this contract requires the contractor to adhere to Operational Security (OPSEC) requirements. OPSEC requirements are additional to the requirements of Part 117 of Title 32 CFR, therefore, the Contractor may not impose OPSEC requirements on its subcontractors unless MSC approves the OPSEC requirements. See OPSEC in the (PWS) for OPSEC requirements and additional guidance.

Item 11(l): All Controlled Unclassified Information associated with this contract must be safeguarded to prevent unauthorized public disclosure. CUI such as FOUO, SCG, and other technical information are not authorized for public release and cannot be placed on a publicly accessible web site or web server. All emails containing such information or attachments, shall be protected per NIST SP-800-171, or subsequent revisions. All transmissions to personal email accounts (AOL, Yahoo, Hotmail, Comcast, etc.) and posting on social media websites (Facebook, Instagram, Twitter, LinkedIn, etc.) are prohibited. Destroy all CUI associated with this contract by any of the following approved methods: A cross-cut shredder; a certified commercial destruction vendor; a central destruction facility; incineration;

chemical decomposition; pulverizing, disintegration; or methods approved for classified destruction.

Item 11(l) continued: 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 Non-federal Information Systems and Organizations or accepted equivalents, shall be incorporated into any InfoSec program the contractor establishes.

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

N3 Project Officer

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL

Donald J. Williams, SCMSRO

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL

LCDR Nick Jordan, OPSEC

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL

COR

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL

Industrial Security PM

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.)

See Item 11(j): OPSEC requirements identified in Item 13.

Contractor must provide VISIT AUTHORIZATION LETTER (VAL) listing all contract personnel located on installations and on-board ships that require or will have access to classified information as well as other contractors that perform contractual services in the installation or on-board ships and require or have access to sensitive unclassified information or those that require routine or frequent "entry" to the installation or on board ships in the performance of other types of contracts, services or maintenance.

The Facility Security Officer shall provide a monthly security clearance report identifying cleared personnel supporting this contract, within 7 working days, to the COR, and immediate notification of any eligibility changes for personnel with access granted to classified.

FAGERHEIM.ERIK.K

ENNET.1031737423

Digitally signed by

FAGERHEIM.ERIK.KENNET.1

031737423 Date: 2024.08.22 12:54:13 -04'00'

WILLIAMS.DONALD

.JEROME.1044816438

Digitally signed by

WILLIAMS.DONALD.JEROME.

1044816438 Date: 2024.09.03 12:37:53 -04'00'

JORDAN.NICHOLAS.

LARRY.1240427229

Digitally signed by

JORDAN.NICHOLAS.LARRY.1

240427229 Date: 2024.08.22 12:41:12 -04'00'

BLANCO.SEAN.MAG

LASANG.1188131316

Digitally signed by

BLANCO.SEAN.MAGLASANG.

1188131316 Date: 2024.08.21 15:02:25 -04'00'

HOLMES.DAMIEN.L

AMONT.1142398229

Digitally signed by

HOLMES.DAMIEN.LAMONT.1

142398229 Date: 2024.09.09 10:18:09 -04'00'

PREVIOUS EDITION IS OBSOLETE. Page 5 of 5DD FORM 254, APR 2018

The MSC Administrative or Operational Commander designated for the contract will be responsible for releasing classified information to the Contractors shipboard personnel and will identify the applicable Security Classification Guide(s) to be used to perform derivative classification.

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.)

The GCA has inspection responsibilities for Government owned and operated vessels, and facilities.

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

a. GCA NAME

Military Sealift Command

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

N32205

c. ADDRESS (Include ZIP Code)

Commander Military Sealift Command 471 East C Street, Building SP-47 Naval Station Norfolk, VA 23511-2419

d. POC NAME

Erik Fagerheim

e. POC TELEPHONE (Include Area Code)

+1 (757) 341-5133

f. EMAIL ADDRESS (See Instructions) erik.k.fagerheim.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)

F. Carley Orvin

b. TITLE

Contracting Officer

c. ADDRESS (Include ZIP Code)

Commander Military Sealift Command, N10 471 East C Street, Building SP-48, Naval Station Norfolk, VA 23511

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

N32205

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

TBD

f. TELEPHONE (Include Area Code)

+1 (757) 341-4628

g. EMAIL ADDRESS (See Instructions) franklin.c.orvin.civ@us.navy.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

20240910

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.)

ORVIN.F

RANKLI

N.C.1284 292703

Digitally signed by

ORVIN.FRANK

LIN.C.12842927

Date: 2024.09.10 07:29:05 -04'00'