Attachment 5 DD254.pdf

Please wait...

If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document.

You can upgrade to the latest version of Adobe Reader for Windows®, Mac, or Linux® by visiting http://www.adobe.com/go/reader_download.

For more assistance with Adobe Reader visit http://www.adobe.com/go/acrreader.

Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc., registered in the United States and other countries. Linux is the registered trademark of Linus Torvalds in the U.S. and other countries.

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PREVIOUS EDITION IS OBSOLETE.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)

Block 11.e.: Contractor is only required to be physically present in an area containing classified information. Actual knowledge of, generation, or production of classified information is not required for performance of the contract. Cleared personnel are required to perform this service because security measures which are in force do not preclude access to classified information.

SWFLANT Security Classification Guidance: OPNAVINST 5513.5c SCG ID# 05-027.7 and updated versions. Security Guidance:

DoD 5200.01 Vol 1-4 Information Security Program DoD 5220.22-R Industrial Security Regulation DoD 5220.22-M National Industrial Security Program Operating Manual (NISPOM) SECNAVINST 5510.36B Information Security Program SWFLANTINST 5530.7series CUI: SSPINST 5510.38 Protection and Marking of SSP CUI

Item 18.c.: SWFLANT Command Security Manager Attn: Industrial Security Specialist 1150 USS Los Angeles RD Kings Bay, GA 31547 A Visitor Group Security Agreement (VGSA) will be executed with all contractor operations located on SWFLANT that require or will have access to classified information.

Visit Access Requests (VAR) will be submitted through JPAS to the host SMO Code (68733) on an annual basis for all contractors.

Contract Completion Date:

Block 10.j.: FOUO: Electric Transmission of SWFLANT Controlled Unclassified Information (CUI) will be protected and handled under SECNAV 5510.36 and SSPINST 5230.11.

For Official Use Only (FOUO) Information: FOUO only applies to Unclassified information that may be exempt from mandatory release to the public under exemptions 2 through 9 of the Freedom of Information Act (FOIA). Only the originator or other competent authority shall determine if the information qualifies to be designated FOUO or not. DoD contractors are responsible for handling and protecting FOUO information.

Unclassified documents containing FOUO information shall be marked "FOR OFFICIAL USE ONLY" at the bottom, on the outside of the front cover (if any), and on each page containing FOUO information, on the back page, and on the outside of the back cover (if any). Individual paragraphs that contain FOUO information shall be marked "(FOUO)" at the beginning of the paragraph.

Mark other records, such as computer printouts, photographs, films, tapes, slides, etc. "FOR OFFICIAL USE ONLY" or "FOUO" in a way that insures the recipient or viewer knows the records contain FOUO information.

FOUO information may be transmitted within and between DoD agencies, DoD contractors, consultants and grantees as necessary in the conduct of official business. FOUO documents and material may be transmitted via first class mail, parcel post or for bulk shipments, fourth class mail. Electronic transmission of FOUO information (voice, data, or facsimile) should be via approved secure communications systems whenever practical.

Facsimile communications marked FOUO may be transmitted by nonsecure terminals, upon verifying the identity of the recipients, with the FOUO During working hours, reasonable steps should be taken to minimize risk of access by unauthorized personnel. After working hours, FOUO information shall be stored in unlocked containers, desks or cabinets if Government or Government-contract building security is provided or in locked desks, file cabinets, bookcases, locked rooms or similar items.

When no longer needed, FOUO documents may be destroyed by shredding or tearing into pieces to preclude reconstructing, and placed in a regular trash container.

10.a. SWFLANT COMSEC Rep: (NAME) 1150 USS Los Angeles Rd Kings Bay, GA 31547

(912)573-XXXX & EMAIL

SIGN:_______________________________DATE:________________

10.b. SWFLANT RD/FRD Rep: (NAME) 1150 USS Los Angeles Rd Kings Bay, GA 31547

(912)573-XXXX & EMAIL

SIGN:_______________________________DATE:________________

10.c. SWFLANT CNWDI Rep: (NAME) 1150 USS Los Angeles Rd Kings Bay, GA 31547

(912)573-XXXX & EMAIL

SIGN:_______________________________DATE:________________

10.e. SSP SSO/Scientific and Technical Intelligence Liaison Officer (STILO): (NAME) 1250 10th Street, SE Washington Navy Yard, DC 20374

(202)433-XXXX & EMAIL

SIGN:_______________________________DATE:________________

10.h. SSPLE (FGI) Rep: (NAME) 1250 10th Street, SE Washington Navy Yard, DC 20374

(202)433-XXXX & EMAIL

SIGN:_______________________________DATE:________________

Kings Bay, GA 31547 Address: 1150 USS Los Angeles Rd Kings Bay, GA 31547