Attachment 5- DD Form 254.pdf

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DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of AEM LiveCycle Designer

DD FORM 254, APR 2018

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:

May 31, 2022 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.)

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 254, DoD Contract Security Classification Specification

701 White Avenue Beloit, WI 53511

701 White Avenue Beloit, WI 5351, and Various U.S. Navy ships, subsmarines and shore facilities in CONUS/ OCONUS

NSWCPD Code 105

Phila PA 19112, PAO, 215-897-2002

All contractor personnel assigned to this contract and performing its required services on site as reflected in Item 8 of this DD254 shall be United States citizens and possess a personnel security clearance at the CONFIDENTIAL level. Interim CONFIDENTIAL clearances are acceptable.

Item 10(j): All Controlled Unclassified Information associated with this contract must be protected per the guidance provided for Item 11(l) of this DD Form 254. During working hours, reasonable steps shall be taken to minimize the risk of access by unauthorized personnel. After working hours, CUI information must be stored in locked containers, desks, or cabinets.

Item 11(a): Access to classified information, if applicable, will be provided by the sponsoring Program Office at the performance location reflected in Item 8.a of this DD Form 254, and any other location established per this contract. The contractor shall comply with all access control and visitor procedures when traveling to any location determined by the sponsoring Program Office in performance of this contract.

Item 11(e) 1: This contract is for maintenance or engineering services on equipment that processes classified information at the NSWCPD or its associated cleared facilities. Actual knowledge of, generation, or production of classified information is not required for performance of this contract. Personnel cleared at the Confidential level are required to perform this service because access to classified information cannot be precluded by escorting personnel. Classification guidance needed for performance will be provided by the using activity.

Item 11(j): The Contractor shall protect critical information associated with this contract to prevent unauthorized disclosure. The NSWC Philadelphia Division's (NSWCPD) Critical Information List, will be provided on site, if warranted.

Item 11(j) Continued: Performance under this contract requires the contractor to adhere to OPSEC requirements. The Contractor may not impose OPSEC requirements on its subcontractors unless NSWCPD approves the OPSEC requirements.

Item 11(j) Continued: During the period of this contract, the Contractor may be exposed to, use, or produce, NSWC PD Critical Information (CI) and/or observables and indicators which may lead to discovery of CI. NSWC PD’s CI will not be distributed to unauthorized third parties, including foreign governments, or companies under Foreign Ownership, Control, or Influence (FOCI).

Item: 11(j). Continued: Any attempt by unauthorized third parties to solicit, obtain, photograph, or record, or; incidents of loss/compromise of government Classified or CI, Business Sensitive, Company Proprietary information related to this or other program must be immediately reported to the Facility Security Officer, Defense Counterintelligence & Security Agency and/or the Naval Criminal Investigative Service, and the NSWCPD Operations Security (Code 1051). Questions concerning these requirements shall be directed to the NSWCPD Operations Security (Code 1051).

Item: 11(j). Continued: Performance under this contract requires the contractor to adhere to OPSEC requirements. OPSEC requirements are additional to the requirements of DoD 5220.22-M, National Industrial Security Program Operating Manual, therefore, the Contractor may not impose OPSEC requirements on its subcontractors unless NSWCPD approves the OPSEC requirements.

Item: 11(l). All Controlled Unclassified Information (CUI) associated with this contract must be safeguarded to prevent unauthorized public disclosure. CUI such as FOUO, Security Classification Guides (SCG), and other technical information with Distribution Statements B, C, D, E or F are not authorized for public release and cannot be placed on a publicly accessible web site or web server. All emails containing such information or attachments, shall be protected per NIST SP-800-171. All transmissions to personal email accounts (AOL, Yahoo, Hotmail, Comcast, etc.) and posting on social media websites (Facebook, Instagram, Twitter, LinkedIn, etc.) are prohibited. Destroy all CUI associated with this contract by any of the following approved methods: A cross-cut shredder; a certified commercial destruction vendor; a central destruction facility; incineration; chemical decomposition; pulverizing, disintegration; or methods approved for classified destruction.

Classified or unclassified technical papers to be presented at a classified symposium must be approved by the NSWCPD Contracting Officer's Representative (COR) in concert with NSWCPD, Code 1051 and PEO Subs prior to the presentation.

The Contractor must submit a request for sharing of classified and other sensitive information between prime contracts in writing to the NSWCPD Industrial and Operations Security Code 105. Each request must reference contract number identify in block 2a the specific information for which approval is being sought, a justification for needing to share the information, the name of other contractor and its contract number under which the requested information will be shared.

All classified documents must be destroyed using a National Security Agency (NSA) approved high security crosscut shredder listed on the NSA/CSS evaluated products list (EPL) for high security crosscut paper shredders, or other approved method for destroying classified information.

-All classified information involved in security incidents shall be retained and provided to the certifying official in Item 16 of this DD 254 for classification review.

-All reports of contractor security violations associated with this contract shall be sent by the Cognizant DCSA field office directly to the certifying official in Item 17 of this DD254.

Copies of preliminary inquiry or investigative reports of security incidents involving classified information shall be scanned and forwarded certifying official in Item 17 of this DD254.

This DD254 is for solicitation purposes only; therefore, it must be returned to certifying official in Item 17 be updated with a contract number upon contract award before the contract DD254 can be issued to the contractor.

Vincent S Garcia, OPSEC Program Manager

Philadelphia, PA 19112 Address: NSWCPD 4700 S. Broad Street, Code 1051, Bldg 29 Philadelphia, PA 19112