Attachment 05 Draft DD Form 254.pdf

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Addendum for DD Fm 254, Section 13, dated 20190801

Section 13, addendum information is aligned with the numerical section of the DD FM 254:

10a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION. NOT REQUIRED.

10b. RESTRICTED DATA (RD). NOT REQUIRED.

10c. CRITICAL NUCLEAR WEAPONS DESIGN INFORMATION (CNWDI). NOT REQUIRED.

10d. FORMERLY RESTRICTED DATA (FRD). NOT REQUIRED.

10e. NATIONAL INTELLIGENCE INFORMATION. Access to SI TK G and HCS caveats are authorized in the performance of this contract and requires a final U.S. Government issued security clearance at the designated level. Contractor will comply with the provisions in

Intelligence Community Directive (ICD) 703, Protection of Classified National Intelligence

Including Sensitive Compartmented Information, dated 21 Jun 2013, as amended.

10f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION. NOT REQUIRED.

10g. NORTH ATLANTIC TREATY ORGANIZATION (NATO) INFORMATION. Access to classified NATO information is authorized in performance of this contract. Specialized NATO briefings and a final U.S. Government issued security clearance at the designated clearance level are required for access to classified NATO information. Approval of the Government

Contracting Activity (or designated representative) is required prior to classified NATO access for subcontractors.

10h. FOREIGN GOVERNMENT INFORMATION (FGI). Access to FGI is authorized in performance of this contract and requires a final U.S. Government issued security clearance at the designated level. Access will be granted on a need-to-know basis by the Government

Contracting Activity (or designee) and dissemination will be limited. Prior approval by the Government Contracting Activity (or designated representative) is required for subcontracting.

10i. ALTERNATIVE COMPENSATORY CONTROL MEASURES (ACCM)

INFORMATION. NOT REQUIRED.

10j. CONTROLLED UNCLASSIFIED INFORMATION (CUI). NOT REQUIRED.

10k. OTHER.

11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL:

11a. HAVE ACCESS TO CLASSIFIED INFORMATION AT ANOTHER CONTRACTOR'S FACILITY OR A GOVERNMENT ACTIVITY.

(1) Contractor will provide technical support services for OUSD (Policy) in accordance with the Performance Work Statement (PWS).

(2) Access to U.S. classified information is authorized in performance of this contract and requires a U.S. Government issued security clearance at the designated level.

(3) Contractor will have access to classified information at a Department of Defense facility maintained within the OUSD (Policy) Security Office cognizance.

(4) DoD 5220.22-M, National Industrial Security Program Operating Manual with incorporated changes and supplements apply.

(5) DoD Manual 5200.0, Volume 3, DoD Information Security Program: Protection of Classified Information with incorporated changes and supplements apply.

11b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY. DOES NOT APPLY

11c. RECEIVE, STORE AND GENERATE CLASSIFIED INFORMATION OR MATERIAL. DOES NOT APPLY

11d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE. DOES NOT APPLY

11e. PERFORM SERVICES ONLY. DOES NOT APPLY

11f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE THE U.S., PUERTO RICO, U.S. POSSESSIONS AND TRUST TERRITORIES. NOT REQUIRED

11g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER. NOT REQUIRED

11h. REQUIRE A COMSEC ACCOUNT. NOT REQUIRED

11i. HAVE A TEMPEST REQUIREMENT. NOT REQUIRED

11j. HAVE OPERATIONS SECURITY (OPS EC) REQUIREMENTS. DOES NOT APPLY

11k. BE AUTHORIZED TO USE DEFENSE COURIERS. NOT REQUIRED.

11l. RECEIVE, STORE OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI). DOES NOT APPLY

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:

October 31, 2020 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 List of Attachments [1] (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form) Addendum for DD Fm 254 Block 13.docx

ATTN: Director, Policy Security Office 2100 Defense Pentagon, Room 5E592

WASHINGTON, DC 20301-2100

703-571-9269

Addendum (4 pages) for DD Fm 254, Section 13

All applicable provisions of DoDM 5220.22, Volume 2, "National Industrial Security Program: Industrial Security Procedures for Government Activities," (August 1, 2018) apply.

4800 Mark Center Drive, Suite 09F09 Alexandria, VA 22350 Address: OUSD Policy Security, Room 5E592 2000 Defense Pentagon Washington, DC 20301-2000