Attachment E - 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PREVIOUS EDITION IS OBSOLETE.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

Homeport/Staging Area - JEB Little Creek, VA

471 East C Street, Building SP-64

B. Information Security Requirements(InfoSec). The Contractor shall handle, store, and maintain classified material in compliance with requirements set by DOD 5220.22(series), National Industrial Security Program Operating Manual, and the DD Form 254, DOD Contracts Security Classification Specification for classified contracts. All members who require access to classified information, sensitive information, controlled unclassified information (to include Privacy Act and Personally Identifiable Information (PII) or access to the classified information network shall comply with DoD Manual 5200.01 Vol I - IV (DoD Information Security Program), SECNAV M5510.36 (SECNAV Information Security Program), and DoDD 5240.06 (Counterintelligence Awareness and Reporting - CIAR). The Contractor shall implement InfoSec measures for its contractor furnished unclassified information technology system(s) used in performance of this contract. InfoSec measures shall be compliant with DFARS 252.204-7012, Safeguarding Covered Defense Information and Cyber Incident Reporting. At a minimum, the security standards extracted from the referenced National Institute of Standards and Technology (NIST) Special Publication 800-171, Protecting Controlled Unclassified Information in Nonfederal Information Systems and Organizations or accepted equivalents, shall be incorporated into any InfoSec program the contractor establishes.

C. The Contractor shall be responsible for the storage requirements. See DoD 5220.22-M National Industrial Security Operating Manual (NISPOM) for industrial security guidance, SECNAV M-5510.30 Personnel Security Program for personnel security guidance, and SECNAV M-5510.36 Information Security Program, for information security guidance and guidance on handling FOUO. All classified documents, when no longer needed, shall be destroyed as classified waste in accordance with DoD 5220.M and SECNAV 5510.36.

D. Contract performance requires that designated personnel employed onboard the ship have access to SECRET information regarding the operational employment and safe navigation of the ship. The Contractor shall ensure that any classified information disclosed to its employees is not further released or made available to other employees, or any other person who does not have a comparable clearance and a "Need to Know.

E. The Contractor shall provide annually to the COR, an updated list of all crew members who are designated to have access to classified information.

F. This form must be modified to include subcontractor information, if they are used. The contractor will ensure all subcontractors follow security guidance.

G. See Section C 1.6.12 Operational Security (OPSEC) in the PWS for OPSEC requirements and additional details.

H. Contractor shall provide a Visit Authorization Letter (VAL) listing for all contract personnel located on the installation(s) and on-board the ship(s) that require or will have access to classified information. Contractor shall provide a VAL listing for the other contractors that perform contractual services on the installation(s) or on-board ship(s) that require or will have access to sensitive unclassified information, which includes the other contractors that require routine or frequent "entry" to the installation(s) or on-board the ship(s) in the performance of other types of contracts, services or maintenance. During the performance period of the contract, the Facility Security Officer, shall notify Command Security Manager within 7 working days of any changes to the VAL listing of the contractor personnel.

I. COMSEC information/material will be processed IAW DoD 5220.22-M, Chapter 9, Section 4, and OPNAVINST 2221.5D dtd 8/15/16, 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 to COMSEC is granted. Written concurrence of the NAVSEA Program Manager is required prior to subcontracting.

471 East C Street, Building SP-64 Naval Station Norfolk, VA 23511-2419 Address: Commander Military Sealift Command 471 East C. Street, Bldg SP64