Attachment D-DD254_attachments_9July2021.pdf

DD 254 - SCI Addendum ver001 Contract Number –

US ARMY SCI ADDENDUM

XXX 1. This agreement/contract requires access to Sensitive Compartmented Information (SCI). The Commander, US Army Intelligence and Security Command (INSCOM), acting on behalf of the DA Deputy Chief of Staff (DCS), G-2 as the Cognizant Security Authority (CSA) for the US Army, has exclusive security responsibility for all SCI released to the vendor/contractor or developed under the agreement/contract and held within the vendor’s/Contractor's SCI Facility (SCIF) or Co-utilization Agreement (CUA).

XXX 2. The Defense Intelligence Agency (DIA) has security inspection responsibility for SCI and the Defense Counterintelligence Security Agency (DCSA) retains responsibility for all collateral information released or developed under the agreement/contract and held within the DoD Vendor’s/Contractor's SCIF. All prime and sub-vendor/contractor DD Form 254’s prepared for agreements/contracts involving access to SCI under this agreement/contract must be processed through ACCS to the CM and Industrial Security Specialist for approval.

_XXX_ 3. The vendor/contractor must establish an ACCS account with INSCOM G2. The URL to register for the Army ACCS account used to enter TS/SCI DD254's is;

https://accs.army.mil/registration

XXX 4. The manuals, regulations and directives checked below provide the necessary guidance for physical, personnel, and information security for safeguarding SCI, and are part of the security classification specification for this agreement/contract:

N/A ICD 503, Intelligence Community Information Technology Systems Security Risk Management, Certification and Accreditation

XXX ICD 704 Personnel Security Standards and Procedures Governing Eligibility For Access to Sensitive Compartmented Information and Other Controlled Access Program Information

N/A ICD 705, Technical Specifications for Construction and Management of Sensitive Compartmented Information Facilities.

N/A ICD 705-1, Physical and Technical Security Standards for Sensitive Compartmented Information Facilities.

N/A ICD 705-2, Standards for the Accreditation and Reciprocal Use of Sensitive Compartmented Information Facilities.

XXX Signals Intelligence Security Regulations (SISR) (Available from the CM)

XXX Imagery Policy Series (Available from the CM)

N/A DoDM 5105.21 Vol 1, SCI Administrative Security Manual: Administration of Information and Information System Security https://accs.army.mil/registration

DD 254 - SCI Addendum ver001 Contract Number –

N/A DoDM 5105.21 Vol 2, SCI Administrative Security Manual: Administration of Physical Security, Visitor Control, and Technical Security.

XXX DoD 5105.21 Vol 3, SCI Administrative Security Manual: Administration of Personnel Security, Industrial Security and Special Activities.

XXX AR 380-28, DA Special Security System.

XXX AR 25-2, Information Assurance.

N/A AR 380-381, Special Access Programs (SAPS).

XXX Army Handbook for SCI Contracts.

N/A Other

XXX 5. Contract estimated completion date: 20250430 (PERIOD OF PERFORMANCE

ONLY).

XXX 6. List the name, mailing address, email address and telephone number of the Government Primary and Alternate Contract Monitor (CM) for the SCI portion of this agreement/contract. The Government Program Security Monitor, and the Vendor/Contractor Security Point of Contact’s must be registered in the Army Centralized Contracts Security Portal (ACCS) in order to process SCI actions.

Primary Contract Monitor Cheryl Spears

PEO STRI G1

12211 Science Dr

Orlando, FL 32826

Cheryl.l.spears.civ@mail.mil

(407) 384-5136

Alternate Contract Monitor Stanley Slupski

12211 Science Dr

Orlando, FL 32826-3276

Stanley.m.slupski.civ@mail.mil

(407) 384-3540

Program Security Monitor Stanley Slupski PEO STRI Attn: G2 12211 Science Dr Orlando, FL 32826-3276 Stanley.m.slupski.civ@mail.mil

(407) 384-3540

Contractor Security Point of Contact

PLANNING PURPOSES

XXX 7. All DD Forms 254 prepared for agreements/contracts involving access to SCI under this agreement/contract must be processed through ACCS to the CM and Industrial Security Specialist for approval and to the Contractor Support Element, US INSCOM, ACofS Security, G2 for review and concurrence of the agreement/contract award.

DD 254 - SCI Addendum ver001 Contract Number –

XXX 8. Visit certification to DoD locations is not required, as need to know and accesses is verified at the visiting facility. Non DoD locations the vendor/contractor must process request for SCI visit certification(s) through ACCS to the CM for approval and to Contractor Support Element (CSE) for review and processing. Visit certification request must be submitted at least ten (10) working days prior to the visit.

XXX 9. Debriefings: All CSSO’s/FSO’s must properly debrief all vendors/contractors from SCI through ACCS. CSSO’s/FSO’s must submit the debrief request NLT 7 days and NET 10 days before actual departure. CSSO’s/FSO’s will separate all vendors/contractors from JCAVS after completion of debriefing.

XXX 10. The vendor/contractor will not reproduce any SCI related material without prior written permission of the CM. If permission is approved by the CM, the vendor/contractor will establish and maintain a log (written or electronic) listing all reproduced materials and the disposition of the reproduced items.

XXX 11. Security Classification Guides or extracts are attached or will be provided under separate cover by the CM.

XXX 12. The vendor/contractor will ensure that all Electronic processing of SCI equipment meets the equipment accreditation in accordance with ICD 503 and AR 25-2.

N/A 13. This agreement/contract requires a vendor/contractor controlled SCIF.

N/A 14. This Agreement/Contract requires a SCIF Co-user Agreement (CUA). The vendor/contractor must provide a copy of the CUA to the CM and government Industrial Security Specialist per ICS 705-02!

XXX 15. Request for Indoctrination/Debrief Authority.

XXX 16. This agreement/contract requires X (SI) X (TK) X (G) X (HCS). The vendor/contractor will NOT create or issue any JWICS accounts for agreement/contract personnel without written permission from the AO/KO and Contract Monitors.

XXX 17. The vendor/contractor will perform SCI work under this contract at the following locations

Camp Bullis, TX Fort Bliss, TX Fort Bragg, NC Fort Campbell, KY Fort Carson, CO Fort Drum, NY Gowen Field, ID Grafenwoehr, Germany Fort Hood, TX Fort Huachuca, AZ

DD 254 - SCI Addendum ver001 Contract Number –

Fort Irwin, CA Fort Leavenworth, KS Fort Polk, LA Fort Riley, KS Fort Stewart, GA Joint Base Lewis-McChord, WA Schofield Barracks, HI Yongsan Army Garrison, Korea Camp Casey, Korea Camp Humphreys, Korea Davis Monthan AFB Tucson, AZ Joint Base Dix-McGuire-Lakehurst Camp Atterbury, IN Fort Gordon, GA Los Alamitos, CA Fort Gillem, GA Fort Draper, UT Fort Indiantown, Gap, PA Joint Base Eielson-Wainwright, AK Fort Sheridan, IL

PEO STRI TSMO

Huntsville, AL Cage Code:

XXX 18. The vendor/contractor identified in Block 6 is a Multiple Facility Organization (MFO) and is authorized to submit DD254 and SCI Addendum for the following SCI locations (Facility Name and CAGE Code).

N/A 19. This agreement/contract has a SCI Courier Requirement.

CUI

BRIEFING FOR ACCESS TO CRITICAL NUCLEAR WEAPONS DESIGN

INFORMATION

1. Army regulation 380-150, security access to and dissemination of RESTRICTED

DATA, is the regulation which established policy and prescribes procedures for the safeguarding, access to, and dissemination of RESTRICTED DATA and FORMERLY

RESTRICTED DATA.

2. CRITICAL NUCLEAR WEAPONS DESIGN INFORMATION (CNWDI) is that TOP

SECRET or SECRET RESTRICTED DATA revealing the theory of operation or design of the components of thermonuclear or implosion-type fission bomb, warhead, demolition munition, or test device. Specifically excluded is information concerning arming, fuzing and firing system; limited life components; and total contained quantities of fissionable, fusionable, and high explosive materials by type. Among these excluded items are the components which service personnel set, maintain, operate test, or replace.

3. One must be a US Citizen and possess a final TOP SECRET or SECRET security clearance prior to certification for access to CNWDI. In exceptional circumstances, an immigrant alien may be afforded access to CNWDI. However, such a determination shall be made by the Secretary of Defense or his designee based upon the recommendation of the head of the responsible agency or department.

4. Chapter 5, AR 380-150, limits the number of individuals authorized to certify the need to personnel to have access to RESTRICTED DATA including CNWDI. Certification shall be limited to those who have an established Need-to-Know for CNWDI and a final

TOP SECRET or SECRET clearance. Representatives of The Army Staff Personnel

Security Office (TASPSO) are in no position to determine your Need-to-Know for access to CNWDI; however, we are in a position to determine the status of your citizenship and your security clearance. Procedures have been established whereby your supervisor or commander submits a request for your access to CNWDI. This request is accepted as certification of your Need-to-Know. After verification of your US citizenship and your final TOP SECRET or SECRET security clearance, you have been asked to report to

TASPSO to be briefed on the sensitivity of CNWDI. Chapter 5, AR 380-150, requires such a briefing.

5. CNWDI is considered so sensitive that special markings are required to identify such information. Publication, correspondence, movies, slides, and other documentary media which contain CNWDI generated since May 1973 shall be clearly marked, “CRITICAL

NUCLEAR WEAPON DESIGN INFORMATION DOD DIRECTIVE 5210.2 APPLIES.”

Similar documents published before this requirement, and which are in current working files, will be so marked when they are withdrawn from files for action or reference. The

Atomic Energy Commission does not require the marking on all CNWDI documents generated by AEC; however, they have agreed to issue instructions to their personnel and vendor/contractors providing for CNWDI markings when appropriate on newly generated documents and correspondence transmitted to the Department of Defense.

6. The following requirements will be met in affixing the CRITICAL NUCLEAR WEAPON

DESIGN INFORMATION -- DOD DIRECTIVE 5210.1 APPLIES marking:

a. The words “CRITICAL NUCLEAR WEAPON DESIGN INFORMATION -- DOD

DIRECTIVE 5210.1 APPLIES” in marking or stamping (not typing) will be in capital block letters.

b. All documents will be plainly and conspicuously marked or stamped (not typed) with the CRITICAL NUCLEAR WEAPON DESIGN INFORMATION -- DOD DIRECTIVE

5210.1 APPLIES identification on the front cover, title page, last page, first page of each enclosure/appendix/tab/etc., and back cover. The marking should be placed so that it will not be hidden from view when the pages are clipped or stapled together.

c. Material which does not lend itself to marking or stamping will have a tag, sticker, or similar device bearing the appropriate marking securely attached.

d. The CRITICAL NUCLEAR WEAPON DESIGN INFORMATION -- DOD

DIRECTIVE 5210.1 APPLIES marking will be placed on letters of transmittal and inner envelopes.

e. Electrically transmitted messages containing CNWDI will contain the notional

CRITICAL NUCLEAR WEAPON DESIGN INFORMATION -- DOD DIRECTIVE 5210.1

APPLIES. This notation will appear in the internal instructions at the beginning of the text and may be abbreviated CNWDI. This marking should follow the notation

“RESDAT” on such messages. This requirement is explained in para 2-le (6), AR 380-

150.

7. It is apparent CNWDI from the above requirements that the Department of the Army considers CNWDI to be extremely sensitive information and you are cautioned to handle it accordingly.

Print Name: ______________________________________

Sign Name: ______________________________________

Date: ________________

POLYGRAPH EXAMINATION STATEMENT OF CONSENT

For use of this form see AR 195-6;the proponent is PMG.

FILE NUMBER

LOCATION TIME DATE

NAME (Last, First,Ml) GRADE/STATUS

ORGANIZATION OR ADDRESS

STATEMENT OF CONSENT

In the presence of the witness{es) whose signature(s) appear below, my rights. as specified on DA Form 3881 (completed copy attached).have been explained to me by who informed me that he/she is a polygraphexaminer of the United States Army. Ihave been advised that this polygraph examination statement ofconsent isbeing completed in connection with:

In conjunction with explaining the nature of the polygraph examination. I have been told:

a. that should I refuse to undergo a polygraph examination, no adverse action may be taken against me based solely on my refusal.

b. that I have the right to talk privat ely with a lawyer before, during and after the polygraph examination.

c. that the examination area is equipped with a two-way mirror or observation device.

d. that theexaminationwillbemonitored/recorded.

e. that questioning may occur before, during and after the instrument portion(s) of the polygraph examina tion.

f. that anything I say or do during the polygraph examination may be used againstme in my administrative. military or judicial proceedings.

g. that the polygraph examination will not be conducted without my voluntary consent and even though I am now giving my consent, Ican withdraw it at anytime and the examination will be stopped.

Understanding my unqualified right to refuse, I do hereby this date of my own free will consent to undergo a polygraph examination. I have not been threatened, coerced, unlawfully induced or promised anything in conjunction with my consent to undergo a polygraph examination.

WITNESSES SIGNATURE OF EXAMINEE

SIGNATURE

SIGNATURE OF EXAMINER

TYPED NAME AND ORGANIZATION/ADDRESS

TYPED NAME AND ORGANIZATION OF EXAMINER

SIGNATURE

TYPED NAME AND ORGANIZATION/ADDRESS EXHIBIT NUMBER

DA FORM 2801,JUN 2011 PREVIOUS EDITIONS ARE OBSOLETE. APO LC v1.00

POLYGRAPH EXAMINATION AUTHORIZATION

For use of this form, see AR 195-6; proponent agency is PMG.

DATE OF REQUEST

REPOSITORY I DOSSIER NO

TO: (Authorizing Representative) FROM: (Requesting Agency)

1. Requestauthority to conduct polygraph examination of:

EXAMINEE NAME(Last, First, Middle) OR SOURCE NUMBER

GRADE ISOCIAL SECURITY NO

UNIT, ADDRESS , OR DOD AFFILIATION DATE AND PLACE OF BIRTH

2. The following information is provided:

a. (U) Consistent with circumstances of the case Investigation byother means has been as thorough as circumstances reasonably permit and the development of additional information by means of polygraph examination is essential and timely for the further conduct of the investigation.

b. (U) The proposed examinee has been interviewed and the examination is to be conducted in accordance with AR 195-6.

c. (U) Forcriminal investigationpolygraphexaminations: Theoffensewhichforms the basis fortheinvestigation is punishable under the Uniform Codeof MilitaryJustice bydeath orbyconfinement foratermof one yearor more and there is reasonablecause to believe that theproposed examinee has knowledge of or was involved in the matter under investigation.

d. (U) For military intell gence polygraph examinations: The investigation pertains to an alleged unauthorized disclosure of classified information, alleged acts of espionage, sabotage, treason. subversion , sedition, or disaffection: or the purpose of the investigation is to resolve credible derogatory information indicating allegations of poor character, untrustworthiness, unreliability, or acts which may adversely affect military operations or security, causing substantial doubtthat accessto classifiedinformation isclearlyconsistent with national security;or thepurpose isforforeign nationallimited access authorizationto classified information; orthe proposed examinee isbeing used asanagent or e.

operative in an approved intelligence or counterintelligence operation.

Basis for investigation (Ml: Purpose):

f. ( ) Summarizedjustification for request:

g. (U) Initial request for authorization.

Request confirms telephonic request made on

TYPED NAME, GRADE, POSITION OF REQUESTER SIGNATURE OF REQUESTER

SPECIAL HANDLING INSTRUCTIONS AND NOTICES DOWNGRADING/REGRADING/TERMINATION MARKING

DA FORM 2805, OCT 1976 PREVIOUS EDITIONS OF THIS FORM ARE OBSOLETE

APO LCv3.02ES

TO: (Requesting Agency) DATE

CONDUCT OF POLYGRAPH EXAMINATION IS AUTHORIZED.

THIS CONFIRMSTELEPHONIC AUTHORIZATION GRANTED ON

CONDUCT OF THE POLYGRAPH EXAMINATION IS NOT AUTHORIZED.

PRIOR TO AUTHORIZATION, FURNISH THE FOLLOWING:

REMARKS

TYPED NAME, GRADE, POSITION OF AUTHORIZING REPRESENTATIVE SIGNATURE OF AUTHORIZING REPRESENTATIVE

APO LCv302ES

UNCLASSIFIED//FOR OFFICIAL USE ONLY

(U//FOUO) ANNEX A:

ACKNOWLEDGEMENT AGREEMENT FOR

SIGINT ACCESS AGREEMENT [2017-05710]

DATE:

TO: (U//FOUO) 742nd Military Intelligence Battalion Commander; Support Personnel (Contractor);

NSA/CSS Manager; NSA/CSS Directorate of Operations SIG INT Policy; NSA/CSS Office of General Counsel

FOR: (U//FOUO)

SUBJECT: (U//FOUO) Responsibilities of SSDT under SIG INT Access Agreement [2017-0571 O] l.(U)PURPOSE

A. (U//FOUO) This agreement shall be proof of understanding and acceptance that the above named individual has read the terms of SIGINT Access Agreement [2017-05710] and agrees to abide by the established legal, policy, and oversight rules and regulations contained therein and associated with each agency, relevant to the individual's position. The individual will be working with sensitive compartmented information and the information obtained within SIGINT authorities shall be handled in accordance with all applicable rules and regulations. The terms of this agreement are not waived upon completion of this assignment but remain in effect indefinitely with respect to the intercepted communications and communications-related information to which he/she has been afforded access during the course of this assignment.

(U) Name of the Support Employee:

(U) Period of Detail: to

(U) This agreement will be reviewed annually, or at the end of the detail, whichever occurs first, and may be renewed. If the detail is not renewed or is terminated early, the Intelligence Oversight Officer (100) is responsible for ensuring removal of the individual's SIG INT access.

X

(U//FOUO)Employee:

X

(U//FOUO) LTC Tissa L. Strouse

742nd MI BN Commander

UNCLASSIFIED//FOR OFFICIAL USE ONLY

DATE

DATE

X

(U//FOUO) Mr. Samuel Briley

NSA/CSS Manager

X

(U//FOUO) Appropriate JOO (JOO on MCT)

X

(U//FOUO) NSA/CSS SIGINT Policy cc: 742nd Military Intelligence Battalion Commander Support Personnel NSA/CSS Manager NSA/CSS SIGINT Policy NSA/CSS Office of General Counsel

UNCLASSIFIED//FOR OFFICIAL USE ONLY

DATE

DATE

DATE

SIGNATURE

(U//FOUO) ANNEX B: MEMORANDUM

FOR CONTRACTOR

SIGINT ACCESS AGREEMENT [ORG-2017-05710)

DATE:

TO: (U//FOUO) Support Contractor; 742nd Military Intelligence (MI) Battalion (BN) Representative;

NSA/CSS SIGINT Policy, NSA/CSS Office of General Counsel

FOR: (U//FOUO) Contractor, SUBJECT: (U//FOUO) Responsibilities of 742nd MI BN and Under SIGINT Access Agreement [2017-05710]

1. (U) PURPOSE

A. (U//FOUO) This agreement shall be proof of understanding and acceptance that the contractor, operating under DIRNSA/CHCSS' SIGINT authority and operational control, agrees that representatives of the 742nd MI BN will work with NSA/CSS to ensure that any organizational conflicts of interest have been mitigated in accordance with Federal Acquisition Regulation Subpart 9.5. Further, the 742nd MI BN agrees to provide to NSA/CSS the identity of the Contracting Officer, Contracting Officer Representative, and Security Officer for the contract under which the contractor is performing. Lastly, before any contractor may begin performance within NSA/CSS, the 742nd MI BN shall furnish a copy of this executed memorandum to the contractor.

B. (U//FOUO) The below signature of the 742nd MI BN indicates that the contracting makes the following certifications for the contractor:

1. (U) The contract encompasses the services to be performed (i.e., the services are within the contract's scope) and the place of performance is appropriate under the contract.

2. (U) The performance of services does not create a contractual relationship between NSA / CSS and the contractor or its employees. Privity of contract remains between the contractor and the

7420 MI BN.

3. (U) The contractor services to be performed are for the preponderant benefit of 742nd Ml BN and any benefit to NSA/CSS is incidental. Accordingly, NSA/CSS shall not reimburse 742nd for the costs of the services provided by contractor and its employees, nor will NSA/ CSS entertain any claim for compensation from the contractor. These contractor services are not being provided to NSA/CSS under the Economy Act.

4. (U) The contractor is an independent contractor, and as such, its personnel are not permitted to perform inherently governmental functions, nor shall they be supervised by government personnel.

Determinations of whether functions are inherently government in nature are reserved to NSA/CSS, JAW NSA/CSS Policy 1-39 and USSID SP0025.

5. (U) While supporting NSA/CSS SIGINT activities, the contractor is bound to abide by USSID SP0018, USSID SP0019, and any associated NSA/CSS implementing policies, procedures, and legal interpretations thereof, as well as related NSA/CSS oversight briefings and training.

Contractors will be required to sign a separate acknowledge agreement (Annex A) prior to performing services within NSA/CSS. Any questions on this subject shall be directed to NSA/CSS.

6. (U) The release of SIGINT material to contractors and their personnel shall be handled in accordance with USSID SP025 l. The contractor will provide to NSA/CSS the requisite certifications required by USSID SP025 l.

7. (U) Contractors have satisfied the necessary security requirements (e.g., polygraph, SBI, etc.) and hold appropriate clearances.

8. (U) To avoid any unfair competitive advantage, contractors have signed a precondition agreement obligating them to protect sensitive information to which they may be privy while performing under NSA/CSS authorities. Copies of such precondition agreements shall be provided to

NSA/CSS.

9. (U) Contractors are required to identify themselves as such in meetings and emails, when answering Government telephones and in any other situation where they may be mistaken for Government employees. Contractors shall also identify their work product as contractor prepared.

Contractors shall comply with all applicable NSA/CSS policies including those regarding contractor training, contractor use of government-issued badges; contractor use of government resources and information systems, unauthorized disclosure of government information systems data, and compliance with government facilities related requirements (i.e., parking restrictions, emergency procedures, fire drills and evacuation exercises, safety and health specifications, designated smoking areas, etc.)

10. (U) The 742nd MI BN shall furnish NSA/CSS with, and update NSA/CSS on any changes to, the identities of the SSOT contracting officer, contracting officer's representative, and the contractor staff security officer for the contract under which the contractor is performing.

(U//FOUO) Contract Number:

X Contractor Signature

(U//FOUO)

X Commander Signature

(U//FOUO) Commander Name:

742nd MI BN Commander

X COR Signature

(U//FOUO) COR Name:

Contracting Officer Representative (COR)

X ISSO Signature

(U//FOUO) ISSO Name:

Program Information System Security Officer (ISSO) cc: [SSDT] Contractor [742nd MI BN] Commander, NSA/CSS SIGINT Policy

[PEO STRI] COR, ISSO