Att 01 - DD254.pdf

CLASSIFICATION (When filled in): Unclassified

NRL SER: 017-22

PREVIOUS EDITION IS OBSOLETE. Page 1 of 4DD 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)

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.)

N00173-23-R-JD10

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

PR 67-0912-22/1300992276

DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20230419

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

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

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.)

NAVAL RESEARCH LABORATORY

4555 OVERLOOK AVENUE, SW

WASHINGTON, DC 20375

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

The contractor shall perform on-site experimental and theoretical research in pulsed-power physics and engineering, high-energy density plasma physics, intense laser and charged-particle-beam physics, radiation production and transport, space plasma physics, low-temperature plasma physics, electromagnetic-launcher technology, computational fluid dynamics, production of high-power microwave sources, and the development of new techniques to diagnose and advance these experiments.

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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.)

SIPRnet access may be required

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:

COMMANDING OFFICER, NAVAL RESEARCH

LABORATORY, WASHINGTON DC 20375-5320, CODE 6770

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.)

1. Contractor personnel assigned to this contract, who require access to Top Secret material must possess a favorably adjudicated DoD Tier 5 investigation and a final DoD granted Top Secret personnel security clearance to access classified data under this contract. Contractor personnel who require access to Secret or CUI material must possess a favorably adjudicated DoD Tier 3 investigation and a final DoD granted Secret personnel security clearance. Contractor personnel assigned to this contract as non-critical sensitive must have a submitted DoD Tier 3 investigation.The number of Top Secret/Secret clearances requested from DCSA is anticipated not to exceed 12.

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 Government Information is authorized at cleared US Government/DoD facilities only.

4. Foreign Nationals are only authorized to work on publicly releasable information under this contract.

5. Controlled Unclassified Information (CUI) associated with this contract must be handled/controlled IAW DoD 5200.48.

6. Contractor will NOT be required to receive, generate, or have custody of CLASSIFIED material at the contractor's facility.

NRL SER: 017-22

PREVIOUS EDITION IS OBSOLETE. Page 3 of 4DD FORM 254, APR 2018

7. The contractor is authorized to use the services of the DTIC and is required to prepare and process a DD Form 1540 "Registration for Scientific and Technical Information Services" or online at: http:\\www.dtic.mil\dtic\registration\registration.html. The contractor must do the following actions for access: (1) The sponsoring GCA must submit the DD Form 1540 to DTIC on behalf of the contractor. For subcontractors, the prime contractor submits DD Form 1540 with the GCA verifying the need-to-know. (2) The contractor may also submit DD Form 2345, "Military Critical Technical Data Agreement" (after registration with DTIC) to the Defense Logistics Services Center for access to unclassified, military critical technical data from other DoD sources. The GCA must certify the need-to-know to DTIC.

8. 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 Operations Security (OPSEC) training via DCSA through their CDSE site: https://securityawareness.usalearning.gov/opsec/index.htm; and follow any OPSEC guidance that may pertain to the project.

9. Contractor personnel performing any function designated as a component of the Cyber Security Work Force (CSWF), and/or having privileged user access to NRL information systems and/or networks will require background investigations as specified in SECNAV M-5510.30. Contractors with privileged access shall meet the training and certification requirements specified in SECNAV M-5239.2. A submitted DoD Tier 5 Investigation is required for all with privileged access. Personnel performing these duties must be identified as such on all badge and visit request submissions.

10. Restricted Data (RD)/Formerly Restricted Data (FRD)/Critical Nuclear Weapons Design Information (CNWDI) briefings required. A copy of the signed annual re-briefings must be forwarded to NRL Code 1231 annually. NATO, RD/FRD/CNWDI access is authorized at cleared US Government/DoD facilities only.

11. 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 in block 8.

12. The prime contractor will forward a copy of all proposed subcontracts and task orders to the COR named in paragraph 15, related to this contract, regardless of classification, for review, approval and coordination with the Security official named in block 13. All subcontracts must be approved in writing, by the Security official named in block 13 prior to the start of work.

13. 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.

14. Contractors with privileged access shall meet the training and certification requirements specified in SECNAV M-5239.2. A submitted DoD Tier 5 Investigation is required for all with privileged access. Personnel performing these duties must be identified as such on all badge and visit request submissions.

15. The NRL COR for this contract is Joseph Schumer, NRL Code 6770, (202) 404-4359. The Security point of contact for this contract is Tara Burchick, NRL Code 1231, (202) 767-1380.

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

Tara Burchick, Security Specialist

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL 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 BLOCK 13, PARAGRAPH 8.

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)

BURCHICK.TARA.

NICOLE.1544738980

Digitally signed by

BURCHICK.TARA.NICOLE.154

4738980 Date: 2023.04.19 09:15:01 -04'00'

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PREVIOUS EDITION IS OBSOLETE. Page 4 of 4DD FORM 254, APR 2018

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, SW

WASHINGTON, DC 20375

d. POC NAME

BRENDA GREEN

e. POC TELEPHONE (Include Area Code)

+1 (202) 924-3838

f. EMAIL ADDRESS (See Instructions) brenda.green@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)

SCHUMER, JOSEPH

b. TITLE

BRANCH HEAD, PULSED POWER PHYSICS

c. ADDRESS (Include ZIP Code)

4555 OVERLOOK AVENUE, SW

WASHINGTON, DC 20375

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) 404-4359

g. EMAIL ADDRESS (See Instructions) joseph.schumer@nrl.navy.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

20230419

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.)

1231, 6702 6770

SCHUME

R.JOSEPH

.WADE.12

43848276

Digitally signed by

SCHUMER.JOS

EPH.WADE.124

3848276 Date: 2023.04.19 10:13:06 -04'00'