Attachment 1 - DD 254.pdf

CLASSIFICATION (When filled in):

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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:

October 31, 2020

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.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

TBD

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

TBD

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

TBD

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.)

COMOPTEVFOR

7970 Diven Street Norfolk VA 23505-1498

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

57023

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

COMOPTEVFOR

7970 Diven Street Norfolk VA 23505-1498

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Task-based support to facilitate operational test and evaluation of the system under test for Expeditionary Warfare/Littoral Combat Ship (80) Division as well as will provide technical and analytical support to Commander, Operational Test and Evaluation Force (COMOPTEVFOR) in the definition, conduct, and analysis of structured Operational Test and Evaluation (OT&E) of US Navy Expeditionary Warfare systems. This support will be required in one or more of the following forms: Documentation Review, Operational Test Design, Test Execution, Data Management, Test Planning Support, Test Operations Support, Test Analysis and Reporting, Modeling and Simulation Support, and Program Management Support.

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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 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:

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.)

The following provisions apply for the protection of Controlled Unclassified Information (CUI):

1. Foreign nationals (Non U.S. citizens) will be denied access to CUI unless expressly permitted by the COMOPTEVFOR Command Security Manager.

2. Compliance with COMOPTEVFOR Instruction 5239.7 Protection of Controlled Unclassified Information is required.

8a. Commander Operational Test and Evaluation Force, 7970 Diven St, Norfolk VA 23505-1498.

10 e. Non-SCI intelligence information access is only required due to access to COTF SIPR NETWORK in the performance of this contract.

10 g. NATO information access is only required due to access to COTF SIPR NETWORK in the performance of this contract.

10 j. The "For Official Use Only" information provided under this contract shall be safeguarded as it is applied to COTF instructions.

11 a. Have access to classified information only at another contractors facility or at a government activity identified in Block 8.

11 j. OPSEC requirements IAW: NISPOM, NTTP 3013, Appendix J, OPNAVINST 4332.1A and COTF INST 3432.1C. Sensitive unclassified information–which is also referred to as critical information or critical program information (CPI)–is defined as information that is not classified but which needs to be protected from unauthorized disclosure. Examples are information labeled “For Official Use

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Only (FOUO),”proprietary information, contractor sensitive information, limited distribution information, and Personally Identifiable Information (PII).

NATO BRIEFING IS ONLY REQUIRED TO BE DONE AT COTF AND HELD IN COTF SECURITY. NATO WILL NOT BE PUT INTO JPAS.CLASSIFIED MATERIAL MAY BE REMOVED FROM COTF BY CONTRACTORS WITH THE APPROVAL OF THE SSO/CSM/ACSM. ALL MATERIAL WILL BE ACCOUNTED FOR BY COTF SECURITY AND MUST BE RETURNED UPON

COMPLETION OF THE CONTRACT.

For further information contact the Special Security Officer / Security Manager Kevin Smith 757-457-6406 or, Command COR: Timothy R, Burrows; (757) 457-6056;

Department of the Navy (DON) Personnel Security Program (PSP), SECNAVINST 5510.36A; Department of the Navy Information Security Program, SECNAV M5510.36 , National Industrial Security Program Operating Manual, DOD 5520.22M

a. All Visit requests to activities other than those not listed in the statement of work or this DD 254 shall have "Need to Know" certified by the COMOPTEVFOR Security Department. The Contractor Company will not submit any visit request for their contractors working on this contract. All visit requests will be done by COMOPTEVFOR Security Department. Contract companies are not required to submit any visit request for their employees.

b. All contractors will be required to do a full check-in regardless if they work on-site or off-site. All contractors are required to show up to COMOPTEVFOR with their own Work Authorization Memo (WAM) on company letterhead with an original signature by their companies approving authority. Photo copies of WAMS will not be accepted.

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 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.)

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

Fleet Logistics Center, Norfolk VA

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

N00189

c. ADDRESS (Include ZIP Code)

1968 Gilbert Street, Ste 600 Norfolk VA 23511-3392

d. POC NAME

Ms Kirstin Hofer

e. POC TELEPHONE (Include Area Code)

+1 (757) 443-1977

f. EMAIL ADDRESS (See Instructions) kirstin.hofer@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)

Burrows, Timothy R

b. TITLE

CONTRACTING OFFICER REPRESETNATIVE (COR)

c. ADDRESS (Include ZIP Code)

7970 Diven Street Norfolk VA 23505-1498

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

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

N/A

f. TELEPHONE (Include Area Code)

+1 (757) 457-6056

g. EMAIL ADDRESS (See Instructions)

h. SIGNATURE

i. DATE SIGNED (See Instructions)

20200521

BURROW

S.TIMOT

HY.ROY.1

035399298

Digitally signed by

BURROWS.TI

MOTHY.ROY.1

035399298 Date: 2020.05.21 09:23:31 -04'00'

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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.)