Attachment 4 - Draft DD254.pdf

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DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, MAY 2019

NEEDS DD67

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

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.)

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 254, DoD Contract Security Classification Specification whs.mc-alex.esd.mbx.formswebmaster@mail.mil

WHS

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

LABORATORY. Washington, DC 20375-5320. CODE 6130

1. Contractor personnel assigned to this contract who require access to Top Secret material must possess a favorably adjudicated DoD Tier 5 investigation and a final DoD-granted Top Secret personnel security clearance. Contractor personnel who require access to Secret or unclassified (CUI) material must possess a favorably adjudicated DoD Tier 3 investigation and a final DoD-granted Secret personnel security clearance. The number of Top Secret/Secret clearances requested from DSS is anticipated not to exceed 50.

2. The contractor WILL NOT be required to receive, generate, or have custody of CLASSIFIED material at the contractor's facility.

3. A visit request is required for all personnel assigned to work on this contract, whether on- or off-site. Visit requests must include full name, SSN, contract number, relevant task order task or program name, clearance level/accesses required, and completed investigation date.

4. Foreign Nationals ARE NOT authorized to work on this contract.

5. Controlled Unclassified Information (CUI), such as Proprietary, Privacy Act or FOUO. etc., information associated with this contract, must be handled/controlled IAW DoD 5200.01 Vol. 4.

6. All contractors (including subcontractors) identified in the Statement of Work shall supplement their current security practices by requiring any personnel involved in executing the contract to complete Government-sponsored and administered Operations Security (OPSEC) training (OPSE-130 I) and any OPSEC guidance 1hat may pertain to the project.

7. The prime contractor will forward a copy of all proposed subcontracts and task orders to the COR named in paragraph 14, related to this contract regardless of classification, for review, approval and coordination with the official named in paragraph 16a below. All subcontracts must be approved in writing by the official named in block 16d, prior to the start of work.

8. Restricted Data (RD), Critical Nuclear Weapons Design Information (CNWDI). and Formerly Restricted Data (FRD) briefings are required. The FSO will forward visit request and proof of RD, CNWDI indoctrinations to the NRL COR for need-to-know validation. The COR will forward need to know validations and indoctrinations to Code 1231 for approval. RD, CNWDJ and FRD access is authorized a US Government Facility only.

9. Naval Nuclear Propulsion Information (NNPI) briefings are required and will be provided by the NRL COR prior to access. NNPI access is authorized at the US Government facilities only.

10. For NNPI access, see attached guidance. RD and NNPI is authorized at U.S. Government facilities only. RD and NNPI certifications to other U.S. Government facilities must be forwarded by the official named in block 16d via the NRL COR. Security controls on the dissemination of NNPI guidance, dated 29 Nov 2010 attached [TO ATTACH].

11. Contractor personnel performing any function designated as a component of the Cyber Security Work Force (CSWF), and/or having privileged user access to NRL information systems and/or networks will require background investigations as specified in SECNAV M-5510.30. Contractors with privileged access shall meet the training and certification requirements specified in SECNAV M-5239.2. A submitted DoD Tier 5 Investigation is required for all with privileged access. Personnel performing these duties must be identified as such on all badge and visit request submissions.

12. Contractors issued a DoD interim secret security clearance may ONLY work on unclassified tasks as outlined in the SOW. Unclassified IA or IT positions ARE NOT authorized with a DoD issued interim secret clearance. Contract Facility Security Officers (FSOs) and/or NRL CORs, are required to report immediately to Code 1230 any derogatory information regarding a contractor holding an interim Secret clearance, either on- or off-site. FSOs and NRL CORs shall also notify Code 1230 when a contractor's interim or final clearance has been declined or revoked.

13. For all unclassified tasks included on this contract. 10 be performed at an unclassified or non-controlled access facility, a favorably completed National Agency Check with Local Agency Check (NACLC) is required prior to the start of work.

14. The NRL COR for this contract is Matthew First, NRL Code 6137 (202) 815-1371. The Security POC for this contract is the official named in block 16d.

ACTUAL PERFORMANCE LOCATIONS:

PRIMARY LOCATIONS:

NAVAL RESEARCH LABORATORY

4555 OVERLOOK AVE SW

WASHINGTON DC 20375-5320

NAVAL RESEARCH LABORATORY

MARINE CORROSION FACILITY

KEY WEST. FLORIDA 33040

OTHER U.S. GOVERNMENT FACILITIES AND SHIP YARDS AS NOTED IN THE CONTRACT SOW AS REQUIRED BY THE

COR.