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PREVIOUS EDITION IS OBSOLETE.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

1) Pearl Harbor Naval Shipyard & lntermediate Maintenance: Facility 667 Safeguard street, Suite 100

JBPHH, HI 96860-5033

2) Naval Facilities in Guam -Item 10(a): COMSEC information/material will be processed IA W DoD 5220.22-M, chapter 9, section 4, and OPNAVINST 2221.SC, and any additional security guidelines. Contractor personnel requiring COMSEC access must be: U.S. Citizens and possess a final clearance at the appropriate level. All contractors shall be briefed before: access lo COMSEC is granted. Written concurrence of the KO is required prior to subcontracting.

-Item 10{b) & 10(k)1: (U) Security Controls on the Dissemination of NNPI Received or Generated Under NAVSEA Contracts 12/1/2011 -Item 10(b) & 10(k)2: OPNAVINST, N9210.3 (U) Safeguarding of Naval Nuclear Propulsion lnformation (NNPI) 6/7/2010 -Item 10(b) & 10{k)3: (C-RD) CG-RN-I, REV.3, CHANGES 1-20, DOE-DOD SCG for the NNPP which includes Interpretive Guidance: Bulletins 1-19 -Item 10(b) & 10{k)4: NAVSEA Ltr 08Y:MJM:mjm Ser 08Y/08-00316 of 29 Jan 08 (Encryption of Naval Nuclear Power Propulsion lnformation (NNPI) on Portable Electronic Media and Mobile Computing Devices; Request for Action) -Item I0(b) & I0(k)S: Prior to subcontracting access to RD and NNPI approval of the official in Item 16 of this DD 254 is required.

-Item 18((): NAVSEA 08 -Classified or unclassified technical papers to be presented at a classified symposium must be approved by the PHNSY & IMF Contracting Officer's Representative (COR) prior lo the presentation.

-Security classification guides and controlled unclassified information (CUI) (e.g., FOUO, distribution statement controlled) arc: not authorized for public release; therefore, they cannot be posted on a publicly accessible web-server or transmitted over the internet unless appropriately encrypted. Request for public release cannot be transmitted via the internet until the contractor receives final approval from PHNSY & IMF (Code 1160).

-The subsequent revisions of Security Classification Guide(s) apply to this contract. Subsequent revisions shall be provided by the Government Contracting Activity (GCA) as Government Furnished Information (GFI) and shall be executed by the Contractor at no cost to the government.

-Contractor must submit a request for sharing of classified end other sensitive information between prime contracts in writing to the PHNSY & IMF Security Contracting Officer identified in Item 16 of this form.

-Personnel designated as derivative classifiers shall receive derivative classification training prior to access from the contractor's Facility Security Officer (FSO). The FSO shall ensure personnel receive initial and biennial training during the life of this contract. Evidence of completion, training certificates or equivalent, shall be provided to the Information Assurance Manager no later than the individual's due date.

-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 DSS field office directly to the certifying official in Item 16 or this DD254.

-Forward a copy or subcontractor DD 254s issued under this contract to the official shown in item 16 of this DD254.

-All security related issues, incidents, requests pertaining to this contract shall be presented in writing by the contractor's Facility Security Officer (FSO) to the individual identified in Item 16 of this DD254. The contractor shall abide by other reporting requirements outlined in the NISPOM.

Local Security Instructions. Contractor must comply with the following attachments:

(1): Security Requirements Applicable for Access to Submarines inside Pearl Harbor Naval Shipyard & Intermediate Maintenance Facility's Controlled lndustrial Area (Revised OCT 2013) (2): Extract from DoDM 5200.0I-V4, Enclosure 3, "Protection of FOUO lnformation." In addition a record of any FOUO documents removed from the Ship or Shipyard will be maintained by the Project and all documents shall be returned and accounted for upon completion of the contract.

(3): Pearl Harbor Naval Shipyard & IMF Operations Security (OPSEC) Requirements (Rev. 30 Sep 2016).

NO FURTHER ENTRIES.

667 SAFEGUARD ST. SUITE 100 JBPHH, HI 96860-5033