A1 DD254.pdf

CLASSIFICATION (When filled in): Unclassified

NRL SER: 060-20

NRL SER: 060-20

PREVIOUS EDITION IS OBSOLETE. Page 1 of 4DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE. Page 1 of 4DD FORM 254, MAY 2019

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:

20220531

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

Secret

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

a. PRIME CONTRACT NUMBER (See instructions.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

N00173-20-R-RJ03

DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20200527

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.N00173-16-C-2010

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

FOR RFP PURPOSES ONLY; NOT VALID FOR

ACTUAL CONTRACT AWARD

b. CAGE CODE

N/A

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

DEFENSE COUNTERINTELLIGENCE AND

SECURITY AGENCY

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

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.) Add Row Remove last Row Delete All Rows

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

SEE BLOCK 13

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

N/A

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

N/A

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

SUPPORT CODE 8240 AS NEEDED.

NRL SER: 060-20

NRL SER: 060-20

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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.)

JWICS, SIPRNET

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 DoDM 5200.01, Volume 4 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:

PUBLIC RELEASE OF ANY INFORMATION, TO INCLUDE

SCI, CONCERNING THIS CONTRACT IS NOT AUTHORIZED.

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.)

1. Contractor Sensitive Compartmented Information (SCI) work/access is granted at the cleared U.S. Government/DoD facilities only.

Contractors requiring SCI access must be US citizens, possess a final DoD granted TOP SECRET security clearance, based on a favorably adjudicated DoD Tier 5 investigation; be ICD 704 eligible, and be indoctrinated for the applicable SCI compartments prior to access.

Names of contractor personnel requiring SCI access will be submitted to the SCI POC named in para 11. Contractor personnel requiring access to non-SCI classified material or unclassified information at NRL; or requiring non-SCI access at another cleared U.S. Government/ DoD facility must be a US citizen; have at least a favorably adjudicated DoD Tier 3 investigation and a final SECRET clearance, and have prior approval of the COR and SCI POC named in para 11 to work on this contract. The number of DCSA requested clearances is limited to 6.

2. NATO briefings required. NATO access authorized at SECRET level only. Initial NATO briefings must be within a 5 year scope of the completed investigation. Visit request and a copy of NATO indoctrination must be sent to Code 1231 prior to access. NATO briefing date must be within the current year. Annual refresher briefings for NATO access are required. A copy of the signed annual re-briefings must be forwarded to NRL Code 1231 annually. NATO access is authorized at cleared US Government/DoD facilities only.

3. Foreign Nationals are not authorized to work on this contract.

NRL SER: 060-20

NRL SER: 060-20

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4. Classified information or Controlled Unclassified Information (CUI), such as Proprietary, Privacy Act or FOUO, etc., information associated with this contract, must be handled/controlled IAW DoD 5200.01 Vol. 4.

5. The contractor will be required to generate, receive or store SECRET material at the contractor's facility during performance of this contract. Contractor must return all classified information generated in conjunction with this contract to the COR named below at the completion of this contract.

6. COMSEC briefings required and processed through NRL COMSEC, Code 1222, (202) 767-7481.

7. All contractors (including subcontractors) identified in the Statement of Work shall supplement their current security practices by requiring any personnel involved in executing the contract to complete Government-sponsored and administered Operations Security (OPSEC) training, OPSE-1301 and any OPSEC guidance that may pertain to the project.

8. Visit requests and Need-to-know certifications are required for all personnel on this contract. Visit requests must include full name, SSN, contract number, clearance level, date of closed investigation and should state if IT access is required. Visit requests for OTHER U.S.

Government/DoD contractor facilities will be processed through the contractor FSO. Authorized work locations for this contract are listed below.

9. The prime contractor will forward a copy of all proposed subcontracts and task orders to the COR named in paragraph 11, related to this contract, regardless of classification, for review, approval and coordination with the official named in block 16d below. All subcontracts must be approved in writing, by the official named in block 16d below prior to the start of work.

10. Contractors issued a DoD interim secret security clearance may ONLY work on unclassified tasks as outlined in the SOW. Unclassified IA or IT positions are NOT authorized with a DoD issued interim secret clearance. Contract Facility Security Officers (FSOs), and/or NRL CORs, are required to report immediately to Code 1230 any derogatory information regarding a contractor holding an interim Secret clearance, either on- or off-site. FSOs and NRL CORs shall also notify Code 1230 when a contractor’s interim or final clearance has been declined or revoked.

11. The NRL COR for this contract is Stephen Arnold, NRL Code 8242, (202) 161-2119. The NRL SCI point of contact is Oscar Barrow, NRL Code 1232, (202) 767-0862. The Security point of contact for this contract is the official named in block 16d.

ACTUAL PERFORMANCE LOCATIONS:

NAVAL RESEARCH LABORATORY

4555 OVERLOOK AVENUE, SW

WASHINGTON, DC 20375

OTHER SITES TO BE DETERMINED AFTER AWARD

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

Oscar A. Barrow, NRL SSO

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 ATTACHED SCI ADDENDUM. SEE BLOCK 13, PARAGRAPH 7.

15. INSPECTIONS

NRL SER: 060-20

NRL SER: 060-20

PREVIOUS EDITION IS OBSOLETE. Page 4 of 4DD FORM 254, MAY 2019

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.)

NRL SIO HAS EXCLUSIVE SECURITY RESPONSIBILITY FOR SCI CLASSIFIED MATERIAL STORED, RELEASED OR

DEVELOPED UNDER THIS CONTRACT.

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

a. GCA NAME

NAVAL RESEARCH LABORATORY

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

N00173

c. ADDRESS (Include ZIP Code)

4555 OVERLOOK AVENUE

WASHINGTON, DC 20375, SW

d. POC NAME

JAMES D. MILLARD

e. POC TELEPHONE (Include Area Code)

+1 (202) 767-2576

f. EMAIL ADDRESS (See Instructions) dave.millard@nrl.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)

MILLARD, JAMES D.

b. TITLE

BRANCH HEAD- INFORMATION SECURITY

c. ADDRESS (Include ZIP Code)

4555 OVERLOOK AVENUE

WASHINGTON, DC 20375, SW

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

N00173

e. CAGE CODE OF THE PRIME CONTRACTOR

(See Instructions.)

f. TELEPHONE (Include Area Code)

+1 (202) 767-2576

g. EMAIL ADDRESS (See Instructions) dave.millard@nrl.navy.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

20200610

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.)

1222, 1231, 1232, 8202, 8242

DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, MAY 2019

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:

20220531 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 whs.mc-alex.esd.mbx.formswebmaster@mail.mil

WHS

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

FOR RFP PURPOSES ONLY; NOT VALID FOR ACTUAL CONTRACT AWARD

Name:

N/A

N/A

CSO:

N/A

SEE BLOCK 13

Block9:

SUPPORT CODE 8240 AS NEEDED.

2. NATO briefings required. NATO access authorized at SECRET level only. Initial NATO briefings must be within a 5 year scope of the completed investigation. Visit request and a copy of NATO indoctrination must be sent to Code 1231 prior to access. NATO briefing date must be within the current year. Annual refresher briefings for NATO access are required. A copy of the signed annual re-briefings must be forwarded to NRL Code 1231 annually. NATO access is authorized at cleared US Government/DoD facilities only.

3. Foreign Nationals are not authorized to work on this contract.

4. Classified information or Controlled Unclassified Information (CUI), such as Proprietary, Privacy Act or FOUO, etc., information associated with this contract, must be handled/controlled IAW DoD 5200.01 Vol. 4.

5. The contractor will be required to generate, receive or store SECRET material at the contractor's facility during performance of this contract. Contractor must return all classified information generated in conjunction with this contract to the COR named below at the completion of this contract.

6. COMSEC briefings required and processed through NRL COMSEC, Code 1222, (202) 767-7481.

7. All contractors (including subcontractors) identified in the Statement of Work shall supplement their current security practices by requiring any personnel involved in executing the contract to complete Government-sponsored and administered Operations Security (OPSEC) training, OPSE-1301 and any OPSEC guidance that may pertain to the project.

8. Visit requests and Need-to-know certifications are required for all personnel on this contract. Visit requests must include full name, SSN, contract number, clearance level, date of closed investigation and should state if IT access is required. Visit requests for OTHER U.S. Government/DoD contractor facilities will be processed through the contractor FSO. Authorized work locations for this contract are listed below.

9. The prime contractor will forward a copy of all proposed subcontracts and task orders to the COR named in paragraph 11, related to this contract, regardless of classification, for review, approval and coordination with the official named in block 16d below. All subcontracts must be approved in writing, by the official named in block 16d below prior to the start of work.

10. Contractors issued a DoD interim secret security clearance may ONLY work on unclassified tasks as outlined in the SOW. Unclassified IA or IT positions are NOT authorized with a DoD issued interim secret clearance. Contract Facility Security Officers (FSOs), and/or NRL CORs, are required to report immediately to Code 1230 any derogatory information regarding a contractor holding an interim Secret clearance, either on- or off-site. FSOs and NRL CORs shall also notify Code 1230 when a contractor’s interim or final clearance has been declined or revoked.

11. The NRL COR for this contract is Stephen Arnold, NRL Code 8242, (202) 161-2119. The NRL SCI point of contact is Oscar Barrow, NRL Code 1232, (202) 767-0862. The Security point of contact for this contract is the official named in block 16d.

ACTUAL PERFORMANCE LOCATIONS:

NAVAL RESEARCH LABORATORY

4555 OVERLOOK AVENUE, SW

WASHINGTON, DC 20375

OTHER SITES TO BE DETERMINED AFTER AWARD

WASHINGTON, DC 20375, SW