Attachment (17) Leesville MTCCS II Sample DD254_CUI.pdf

CUI

ATTENTION

ATTENTION

CUI

All individuals handling this information are required to protect it from unauthorized disclosure.

Handling, storage, reproduction, and disposition of the attached document(s) must be in accordance with 32 CFR Part 2002 and applicable agency policy.

Access to and dissemination of Controlled Unclassified Information shall be allowed as necessary and permissible to any individual(s), organization(s), or grouping(s) of users, provided such access or dissemination is consistent with or in furtherance of a Lawful Government Purpose and in a manner consistent with applicable law, regulations, and Government-wide policies.

Standard Form 901 (11‐18)

Prescribed by GSA/ISOO | 32 CFR 2002

Controlled by: US Army ACC Orlando Controlled by: MTC III AC AMIM-HDO-T CUI Category: General Procurement and Acquisition Distribution/Limited Dissemination Control: FEDCON POC: Daniel Steinhauer/407-208-5820

CLASSIFICATION (When filled in): Unclassified

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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)

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.)

W900KK-22-R-0035

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

W900KK-22-F-Leesville

DUE DATE (YYYYMMDD)

20221031

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20220901

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.)

Berry Mission Training Complex (MTC) ACoS, G3, JRTC and Leesville, LA, 71459

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

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

Security and Intelligence Division, DPTMS 1716 3rd St, Bldg 250 Leesville, LA, 71459 Comm: 337-531-7415

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Services include support in conducting computer driven Live, Virtual, Constructive and Games for Training (GFT) simulation exercises for Active Army, Army Reserve, Army National Guard and other units in Joint, Combined and Service oriented command and staff actions from Individual through Brigade / BCT level. The contractor shall provide the services under this contract, to include individual through collective mission command training, support to mission rehearsal exercises, staff planning, leader training/development, live simulations, virtual simulations, constructive simulations, GFT, database preparation and maintenance; scenario creation; contractor controller training and functions; exercise controller training; marketing of available systems and exercises, simulations/simulators operation and management, and post exercise actions, to include facility cleanup, and maintenance; installation and maintenance of communications lines, circuits, and equipment, network and system administration on simulations network, NIPR and SIPR Local Area Networks (LAN), and functional area research.

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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)

Army Contracting Command - Orlando Pubic release of SCI is NOT authorized

Public Release Authority:

Army Contracting Command - Orlando

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. The contractor shall comply with the Security Agreement (DD Form 441) and Security Regulations (DoDM 5200.01 Volumes 1 thru 4) DoD Information Security Program, (DoD 5220.22-M) National Industrial Security Program Operating Manual (NISPOM) current versions and AR 25-2, AR 380-67 , AR 380-10 and affiliated regulations .

2. The contractor's employees requiring access to government or another cleared contractor's facilities where proof of a security clearance is required, the contractor shall meet the security access requirements specified by the host and/or owner of those facilities.

3. Companies that are Foreign Owned, Controlled or Influenced (FOCI) must meet the requirements of DoD 5220.22M National Industrial Security Program Operating Manual (NISPOM) volume 3 and have the appropriate DSP license and or Technical Assistance Agreement (TAA) signed and approved prior to working on this contract.

4. The contractor is not authorized to publicly disclose or release Sensitive Compartmented Information (SCI) program or collateral Classified Military Information (CMI) information. Disclosure or release is not authorized to other DOD organizations or agencies without

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review and written approval from the Requiring Activity Cognizant Security Office and Special Security Officer (SSO).

a. The contractor is not authorized to disclose or release Controlled Unclassified Information (CUI) Technical Data and Critical Program Information (CPI) pertaining to this contract to the public, without prior review and approval from the government Public Affairs Officer, Contracting Officer Representative (COR), and Requiring Activity Cognizant Security Office. Requests for disclosure or release shall be submitted 10 working days in advance to the address specified in block 12.

b. The contractor is not authorized to disclose or release any program Classified Military Information (CMI) Controlled Unclassified Information (CUI) Technical Data or Critical Program Information (CPI) pertaining to this contract or programs to any Foreign Nationals or Foreign Representatives without prior review and approval from the government Contracting Officer Representative (COR) and Requiring Activity Cognizant Security Office Foreign Disclosure Officer (FOO). Requests for disclosure or release shall be submitted 10 working days in advance to the address specified in block 16.

5. Prior to granting a contractor employee access to classified materials, the contractor FSO shall brief employees with regard to their obligation to comply with the terms of the security regulations listed in paragraph 1. The contractor's employees shall be debriefed when access to the material is terminated. A list of all employees who have had access to the classified military information (CMI), controlled unclassified information (CUI) and Technical data during the performance period of this Contract I Delivery Order shall be maintained by the contractor FSO and made available to the COR, Requiring Activity Cognizant Security Office and Defense Security Service (DSS) for inspection upon request.

6. The contractor may award subcontracts in furtherance of this effort. If access to classified , controlled unclassified information and technical data is required, the prime contractor is responsible to ensure compliance by the subcontractor for all security requirements.

Copies of all subcontractor DD Forms 254 shall be forwarded to the Contracting Officer Representative (COR) and the Requiring Activity Cognizant Security Office at the address listed in block 16d and the Defense Security Services (DSS).

7. Currently, there is no security classification guide which is directly applicable to this effort. If, during this effort, it becomes necessary to create classified documentation for which there is no clear classification authority , the contractor shall notify the Contracting Officer Representative (COR), Contract Monitor (CM), who will seek the assistance and appropriate guidance from the local Cognizant Security Office for assistance.

8. Contractors with security clearances shall comply with threat awareness training and reporting requirements per paragraph 1-14 of AR 381-12 . Additionally the contractor shall report threat-related incidents, behavioral indicators to the Requiring Activity Cognizant Security Office.

9. The contractor shall comply with security procedures in effect at government sites visited, and where contract work takes place. All Primary Contractor work will take place at Leesville, LA.

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

Howard A.Thrasher

(BILLET)

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.)

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The Contracting Officer is responsible for ensuring contractor compliance with the security terms of the DD 254 blocks 10,11,12,13. The Contracting Officer will verify and emphasize the contractor's security responsibilities during the life of the contract.

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

a. GCA NAME

Army Contracting Command

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

W900KK

c. ADDRESS (Include ZIP Code)

U.S. Army Contracting Command - Orlando 12211 Science Drive, Orlando, FL 32826

d. POC NAME

Jason C. Graham

e. POC TELEPHONE (Include Area Code)

+1 (407) 208-3079

f. EMAIL ADDRESS (See Instructions) jason.c.graham8.civ@mail.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)

b. TITLE

Security Manager

c. ADDRESS (Include ZIP Code)

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

W900KK

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

f. TELEPHONE (Include Area Code)

g. EMAIL ADDRESS (See Instructions)

h. SIGNATURE

i. DATE SIGNED (See Instructions)

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.)