Attachment 2. BUMED N57_dd0254.pdf
PDF 71 KB Posted
- Attached to
- Process Improvement and Project Management Support Federal contract opportunity
- Solicitation number
- N0018926QB036
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Solicitation Amendment N0018926QB0360002 SF 30.pdf | ||
| Attachment 3. Answers to Contractor Questions.xlsx | XLSX spreadsheet | |
| Attachment 4. PII and PHI.pdf | ||
| Attachment 5. HIPAA Compliant Business Associate Agreement DON -July 2025.pdf | ||
| Attachment 2. Quote Breakdown Template.xlsx | XLSX spreadsheet | |
| Solicitation Amendment N0018926QB0360001.pdf | ||
| Attachment 1. PPIF.docx | DOCX document | |
| Solicitation - N0018926QB036.pdf |
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PREVIOUS EDITION IS OBSOLETE.
Page of
DD FORM 254, APR 2018
NEEDS DD67
(Updated 20250722)
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:
August 31, 2025 The public reporting burden for this collection of information, 0704-0567, is estimated to average 36 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.)
List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form)
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 Form 254, "DoD Contract Security Classification Specification"
| CurrentPage: |
| PageCount: |
| Classification (when form is filled in) (automatically filled from previous drop-down list): |
| Serial Number: |
| 1. CLEARANCE AND SAFEGUARDING - a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED |
(See Instructions) - Select from drop-down list: 2
| 1. CLEARANCE AND SAFEGUARDING - b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/MATERIAL REQUIRED AT CONTRACTOR FACILITY - select from drop-down list: 4 |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "a. ORIGINAL (Complete date in all cases.) ": 0 |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "a. ORIGINAL (Complete date in all cases.) ": 1 |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - a. PRIME CONTRACT NUMBER (See instructions.): |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "b. REVISED (Supersedes all previous specifications.)": 0 |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "b. REVISED (Supersedes all previous specifications.)": 0 |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - b. SUBCONTRACT NUMBER: |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "c. FINAL (Complete Item 5 in all cases.)": 1 |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "c. FINAL (Complete Item 5 in all cases.)": 0 |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER: |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER - DUE DATE (YYYYMMDD): |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - a. ORIGINAL (Complete date in all cases.) : |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - REVISION NUMBER: |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - DATE (YYYYMMDD): |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.): |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.) - DATE (YYYYMMDD): |
| 15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 1 |
| 15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 1 |
| 15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 1 |
| 15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 1 |
| 15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0 |
| 15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0 |
| 15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0 |
| 15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0 |
| 4. IS THIS A FOLLOW-ON CONTRACT? - If yes - Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract. - Enter preceding contract number.: |
| 5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of (period) - Enter contractor's request date in format YYYYMMDD.: |
| E5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of - Enter period.: |
| 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): Dupervil, Marjorie |
| 17. CERTIFICATION AND SIGNATURES - e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.): N/A |
| 8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): Bureau of Medicine and Surgery 7700 Arlington BLVD Falls Church, VA 22042 |
| 8. ACTUAL PERFORMANCE (Click button to add more locations.) - Select to add row : |
| 8. ACTUAL PERFORMANCE - Select to remove last row: |
| 13. SECURITY GUIDANCE - Select to delete all signature rows: |
| 8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): Bureau of Medicine and Surgery 7700 Arlington BLVD Falls Church, VA 22042 |
| Enter general unclassified description of this procurement.: Navy Medicine (NAVMED) requires services for its mission to support continuous improvement processes throughout the command. The mission is to provide continuous improvement and organizational learning to increase readiness. NAVMED is required to promote safe and quality healthcare and operational readiness and support through the coordination, integration, innovation of cutting edge healthcare service and medical research, and replication of success across Navy Medicine leveraging process improvement initiatives. |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 1 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 1 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "b. SUBCONTRACTOR.": 1 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "b. SUBCONTRACTOR.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "b. SUBCONTRACTOR.": 1 |
| 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.) - Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0 |
| 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.) - Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 1 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0 |
| 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.) - Select for "h. REQUIRE A COMSEC ACCOUNT.": 0 |
| 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.) - Select for "h. REQUIRE A COMSEC ACCOUNT.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0 |
| 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.) - Select for "i. HAVE A TEMPEST REQUIREMENT.": 0 |
| 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.) - Select for "i. HAVE A TEMPEST REQUIREMENT.": 0 |
| 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: Select for "(1) Sensitive Compartmented Information (SCI).": 0 |
| 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: Select for "(2) Non-SCI.": 0 |
| 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.) - Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1 |
| 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.) - Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1 |
| 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.) - Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0 |
| 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.) - Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Enter specification for "other." (If more room is needed, continue in Item 13 or on additional page if necessary.): |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 1 |
| 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.) - Select for "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.): 1 |
| 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.) - Select for "m. OTHER.": 0 |
| 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) - Select for "DIRECT": 0 |
| 12. PUBLIC RELEASE - Select for "THROUGH": 1 |
| 12. PUBLIC RELEASE - Enter specification for "through".: Not authorized |
| 12. PUBLIC RELEASE - Public Release Authority:: |
| 13. SECURITY GUIDANCE - Select to add signature row: |
| 13. SECURITY GUIDANCE - Select to remove last signature row: |
| Reviewing Official’s Office Symbol, phone and email (6): 10g. NATO Awareness briefing is required for SIPRNET access. |
COR: LT Heather Lancellotti, heather.n.lancellotti.mil@health.mil; ACOR: Nathalie Jackson, nathalie.n.jackson.civ@health.mil KO: Vincent Conicelli, vincent.j.conicelli.civ@us.navy.mil
Contractors assigned to BUMED HQ to support this contract will have access to classified information the performance of their duties. Furthermore, since contractors' work with personnel located inside a classified vault (N3/N5 vault) therefore, must posses at a minimum, a secret clearance for application development.
Examples of required access include, but not limited to:SIPR email/ DOD/ NAVAL Messages/ ONEBRIEF/ SIPR shared drive, etc
| List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form) - Click on this button to attach a file(s).: |
| NAME & TITLE OF REVIEWING OFFICIAL (6): |
| 17. CERTIFICATION AND SIGNATURES - h. SIGNATURE : |
| 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) - a. GCA NAME: NAVSUP FLC Norfolk - Philadelphia |
| 17. CERTIFICATION AND SIGNATURES - d. AAC OF THE CONTRACTING OFFICE (See Instructions): N00189 |
| 17. CERTIFICATION AND SIGNATURES - c. ADDRESS (Include ZIP Code): NAVSUP Fleet Logistics Center 700 Robbins Avenue, BLDG 2B |
Philadelphia, PA 19111
17. CERTIFICATION AND SIGNATURES - c. ADDRESS (Include ZIP Code): 7700 Arlington BLVD Falls Church, VA 22042
| 16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - d. POC NAME: |
| 17. CERTIFICATION AND SIGNATURES - f. TELEPHONE (Include Area Code): 7036819117 |
| 17. CERTIFICATION AND SIGNATURES - g. EMAIL ADDRESS (See Instructions): marjorie.dupervil.civ@health.mil |
| 17. CERTIFICATION AND SIGNATURES - b. TITLE : Security Specialist |
| 17. CERTIFICATION AND SIGNATURES - i. DATE SIGNED (See Instructions): |
File details come from the government source that posted it. Updated .