Att XI_DD254.pdf

CLASSIFICATION (When filled in):

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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:

May 31, 2022

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

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

Defense Security Services Industrial Security Field Office-Melbourne, FL 7341 Office Park Place Suite #203 Melbourne, FL 32940

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.)

CSG-4 Training Support Vessels Carrier Strike Group Four (CSG-4) U.S. Fleet Forces Command

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

09577

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

Carrier Strike Group Four 1540 Gilbert Street Norfolk. VA 23511

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Contract provides for civilian crews for Carrier Strike Group Four Training Support Vessels to support a wide array of military training mission, including threat simulation; Information Warfare (IW) services; maritime interdiction operation (MIO) training support; and mine laying/retrieval.

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DD 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.)

Access to Controlled Unclassified Information (CUI)

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)

CSG-4 Training Support Vessel Program Manager, Wayne Gittelman (N02-TSVPM)

Public Release Authority:

Carrier Strike Group FOUR

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.)

Contractor performance is restricted to the Carrier Strike Group Four (CSG-4) Training Support Vessels, Carrier Strike Group Four and associated Fleet Training Activities and other locations as prescribed by CSG-4 on an as required basis. In addition to clearance within, only employees certified by the contractor to the be U. S. citizens or U. S Nationals will be permitted access to the United States work site. Contractors requiring access must have a minimum of SECRET Security Clearance. Access to TOP SECRET documents and spaces may be required in relation to training and scenario development. SCI is not required. Specified individuals only require a Top Secret clearance. TOP SECRET program administered by the Fleet Area Special Security Officer (SSO) at the Office of Naval Intelligence, 1084 Pocahontas Street, Building V29, STE 200, Norfolk, VA 23511. Contract services to be performed at the following activities: Commander, Carrier Strike Group Four, Norfolk, VA (SECRET/TOP SECRET) and onboard CSG-4 Training Support Vessels. Classified COMSEC material is not releasable to contractor employees who have not received a FINAL clearance at the appropriate security level. COMSEC access shall be IAW DoD 5220.22M. When access is required at government facilities, contractor personnel shall adhere to COMSEC rules and regulations as mandated by command policy and procedures. Restricted data information is not releasable to contractor employees who have not received a final clearance at the appropriate clearance level. Written concurrence of the KO is required prior to subcontracting. The technical point of contact for

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security issues / access is the CSG-4 Contract Officer Representative, Mr. Wayne L. Gittelman (757 462-1105). Conduct contract support operations in accordance with all applicable security requirements, guidance and command policies. Information generated under the contract shall be marked in accordance with the NATIONAL INDUSTRIAL SECURITY PROGRAM OPERATING MANUAL (DoD 522.22M) and the NATIONAL INDUSTRIAL SECURITY PROGRAM OPERATING MANUAL Supplement (DoD 522.22M Supplement 1).

Contract Expiration Date: XX XXX 20XX

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

Wayne L. Gittelman, Contracting Officers Representative

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL

LCDR Eric Smith, CSG4 SSO

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL

Curt Clarke, Command Security Manager

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.)

TEMPEST information is not releasable to contractor employees who have not received a FINAL CLEARANCE at the appropriate security level.

TEMPEST compliance will be IAW Dept of Navy Information Assurance (IA) PUB MODULE 5239-31 and NSTISSAM TEMPEST/2-95, RED/BLACK Installation Guidance. OPSEC compliance will be IAW OPNAV INSTRUCTION 3432.1A.

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

NAVSUPP FLC Norfolk Contracting

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

N00189

c. ADDRESS (Include ZIP Code)

1968 Gilbert Street, Suite 600 Norfolk, VA 23511-3392

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)

Wayne L. Gittelman

b. TITLE

Contracting Officer Representative

c. ADDRESS (Include ZIP Code)

Carrier Strike Group Four 1540 Gilbert ST Norfolk VA 23511-2701

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

N00189

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

f. TELEPHONE (Include Area Code)

+1 (757) 462-1105

g. EMAIL ADDRESS (See Instructions) wayne.gittelman@navy.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

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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.)