Attachment 4 - DD 254.pdf

CLASSIFICATION (When filled in): Unclassified

FA8650-22-S-5002

FA8650-22-S-5002

PREVIOUS EDITION IS OBSOLETE. Page 1 of 4DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE. Page 1 of 4DD FORM 254, MAY 2019

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:

20220531

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

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

FA8650-22-S-5002

DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20210901

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)

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.)

TBD

b. CAGE CODE

(If applicable, see Instructions.)

TBD

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

TBD

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Two-Step Open BAA to solicit innovative technologies and scientific proposals in support of the Functional Materials and Applications Technology area. The first-step provides vehicle for potential offerors to submit a brief descriptive white papers in lieu of full proposals within a 5 year period of time. In the second-step full proposals are requested from those offerors selected in the white paper evaluation process. The BAA will be re-published annually.

FA8650-22-S-5002

FA8650-22-S-5002

PREVIOUS EDITION IS OBSOLETE. Page 2 of 4DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE. Page 2 of 4DD FORM 254, MAY 2019

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.)

Program Protection Plan (PPP)

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)

SEE BLOCK 13

Public Release Authority:

SEE BLK 13

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.)

Ref Blk 12:

THROUGH:

a. AFRL/RXAP, 3005 Hobson Way, Wright-Patterson AFB OH 45433-7750, for non-SAR related material. Transmission of public release request via e-mail is not authorized.

PUBLIC RELEASE AUTHORITY:

a. 88 ABW/PA, 5135 Pearson Rd, Bldg 10, WPAFB OH 45433, (937) 257-1387.

b. Information requiring AF or DoD-level review will be forwarded by the entry-level public affairs office thru the MAJCOM/DRU Public Affairs Office to the Secretary of the Air Force, Office of Public Affairs, Security and Review Division (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330-1690.

FA8650-22-S-5002

FA8650-22-S-5002

PREVIOUS EDITION IS OBSOLETE. Page 3 of 4DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE. Page 3 of 4DD FORM 254, MAY 2019

BLK 13:

The National Industrial Security Program Operating Manual (NIPSOM), February 2006, Incorporating Change 2, dtd 18 May 16, is the authoritative manual concerning baseline standards for the protection of classified information in connection with classified contract and activities under the National Industrial Security Program.

a. Ref Blk 10e(2): Contractor will require access to intelligence information and must comply with AFI 14-303/AFMC Supplement 1.

The Program Manager has determined that disclosure does not create an unfair competitive advantage for the contractor of a conflict of interest with the contractor's obligation to protect the information and will submit the AFMC Form 210 to AFRL/XP2 for approval prior to granting access.

b. Ref Blk 10j/11l: See DoDM 5200.01, Volume 4, DoD Information Security Program: Controlled Unclassified Information (CUI), for requirements.

c. Ref Blk 11c: Any classified information generated in the performance of this contract shall require the contractor to apply derivative classification and markings consistent with the source material.

d. Ref Blk 11d: The contractor is required to provide adequate and approved storage for classified hardware or material to the level of SECRET which, because of size or quantity, cannot be safeguarded in an approved storage container.

e. Ref Blk 11g: Intelligence information is not releasable to the Defense Technical Information Center (DTIC)

f. Ref Blk 11k: Go to http://www.transcom.mil/cmd/associated/dcd for Defense Courier Service points of contacts and guidance.

g. Transfer of documents to other IR&D efforts is not permitted.

h. IT Level III duties require a favorable completed National Agency Check with written Inquiries (NACI).

i. Program Manager: Marc C. Martin, AFRL/RXAP, 937-255-9645, marc.martin@us.af.mil

j. AFRL/RX Chief, Information Protection: Geraldine “Jerrie” Reese, AFRL/RXOS, 937-255-5559, afrl.rx.security@us.af.mil

List of Attachments (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form)

Program Manager NAME & TITLE OF REVIEWING OFFICIAL

Marc C. Martin Program Manager

SIGNATURE

Chief, Information Protection

NAME & TITLE OF REVIEWING OFFICIAL

Geraldine Reese, Chief IP

AFRL/RXOS

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.)

Ref Blk 10k: Program Protection Plan (PPP) will be provided by the Government activity.

Ref Blk 11j: OPSEC requirements apply. See Statement of Objectives (SOO) for requirements.

MARTIN.MAR

C.C.1228762748

Digitally signed by

MARTIN.MARC.C.1228762748

Date: 2021.09.01 15:40:33 -04'00'

REESE.GERALDI

NE.L.1047572297

Digitally signed by

REESE.GERALDINE.L.1047572297

Date: 2021.09.01 15:48:20 -04'00'

FA8650-22-S-5002

FA8650-22-S-5002

PREVIOUS EDITION IS OBSOLETE. Page 4 of 4DD FORM 254, MAY 2019

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

TBD

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

TBD

c. ADDRESS (Include ZIP Code)

TBD

d. POC NAME

TBD

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)

Mark L. Merrifield

b. TITLE

Contracting Officer

c. ADDRESS (Include ZIP Code)

AFRL/RXKMA

2130 8th Street, Bldg 45 Wright Patterson AFB OH 45433

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

FA8650

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

TBD

f. TELEPHONE (Include Area Code)

+1 (312) 713-9878

g. EMAIL ADDRESS (See Instructions) mark.merrifield@us.af.mil

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.)

AFRL/RX Chief, Information Protection, 2977 Hobson Way, WPAFB OH 45433, afrl.rxsecurity@us.af.mil; Senior Intelligence Officer (SIO), AFRL/XP2, 1864 Fourth Street, WPAFB OH 45433-7301, Capt Amanda Kisor (937) 255-0301, amanda.kisor.1@us.af.mil.

MERRIFI

ELD.MA

RK.L.100

7138101

Digitally signed by

MERRIFIELD.

MARK.L.10071

38101 Date: 2021.09.02 06:30:03 -04'00'