A23 Exhibit H DD254 Contract Security Classification Specification - Post 7 R0.pdf

CLASSIFICATION (When filled in): Unclassified

HQ003421R0003

PREVIOUS EDITION IS OBSOLETE. Page 1 of 7DD FORM 254, APR 2018

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

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED (See Instructions)

Secret

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

Secret

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.)

a. PRIME CONTRACT NUMBER (See instructions.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

HQ003421R0003

DUE DATE (YYYYMMDD)

20210716

3. THIS SPECIFICATION IS: (X and complete as applicable.)

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20210623

b. REVISED (Supersedes all previous specifications.)

REVISION NO. DATE (YYYYMMDD)

c. FINAL (Complete Item 5 in all cases.) DATE (YYYYMMDD)

4. IS THIS A FOLLOW-ON CONTRACT? No Yes If yes, complete the following:

Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract.

5. IS THIS A FINAL DD FORM 254? No Yes If yes, complete the following:

In response to the contractor's request dated , retention of the classified material is authorized for the period of:

6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code)

a. NAME, ADDRESS, AND ZIP CODE

TBD

b. CAGE CODE

TBD

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

TBD

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)

a. NAME, ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

8. ACTUAL PERFORMANCE (Click button to add more locations.)

a. LOCATION(S) (For actual performance, see instructions.)

Raven Rock Mountain Complex Adams County, PA 17214

b. CAGE CODE (If applicable, see Instructions.)

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

RRMC Post 7 Renovations - WHS Multiple Award Construction Contract II (MACC II) Seed Project

HQ003421R0003

PREVIOUS EDITION IS OBSOLETE. Page 2 of 7DD FORM 254, APR 2018

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

b. RESTRICTED DATA

g. NORTH ATLANTIC TREATY ORGANIZATION

(NATO) INFORMATION

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.)

h. FOREIGN GOVERMENT INFORMATION

d. FORMERLY RESTRICTED DATA

i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

e. NATIONAL INTELLIGENCE INFORMATION:

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI) (See instructions.)

k. OTHER (Specify) (See instructions.)

Performance in Government Facilities; CAC; PFAC

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.)

a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT

ANOTHER CONTRACTOR'S FACILITY OR A GOVERNMENT

ACTIVITY

(Applicable only if there is no access or storage required at contractor facility.

See instructions.)

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE, STORE, AND GENERATE CLASSIFIED

INFORMATION OR MATERIAL

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE

e. PERFORM SERVICES ONLY

f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE

THE U.S.,PUERTO RICO, U.S. POSSESSIONS AND TRUST

TERRITORIES

g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE

TECHNICAL INFORMATION CENTER (DTIC) OR OTHER

SECONDARY DISTRIBUTION CENTER

h. REQUIRE A COMSEC ACCOUNT

i. HAVE A TEMPEST REQUIREMENT

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE

l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED

INFORMATION (CUI).

(DoD Components: refer to DoDI 5200.48, only for specific CUI protection requirements. Non-DoD Components: see instructions.)

m. OTHER (Specify) (See instructions.)

Courier Authorizations

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)

DIRECT THROUGH (Specify below) Public Release Authority:

SEE SECTION 13 CONTINUATION SECTION AT THE

BOTTOM OF THIS FORM

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.)

This contract involves access to classified data/information and generating and storing up to SECRET and also involves the contractor having access to CUI and generating and storing CUI. Contractors shall follow all applicable Standard Office Procedures.

FOR ACCESS:

All contractor personnel performing under this contract (Post 7 Renovations) in Government or Contractor provided workspace shall possess a minimum of an active Industrial Personnel Secret clearance, to be unescorted, prior to reporting to any assignment via the RRMC Security Office. For contractor personnel without a clearance; the contractor shall provide an escort(s) who possesses at a minimum of an Industrial Personnel Secret clearance.

FOR CONTRACTOR'S DESIGNERS ACCESS & FOR RECEIVING & GENERATING CLASSIFIED MATERIAL):

All contractor designer personnel performing under this contract (Post 7 Renovations) shall possess a minimum of an active Industrial Personnel Secret clearance prior to reporting to any Post 7 Renovations project assignment via the RRMC Security Office.

HQ003421R0003

PREVIOUS EDITION IS OBSOLETE. Page 3 of 7DD FORM 254, APR 2018

Prior approval of the contracting activity and concurrence of the COR/CM is required for any subcontracting.

The use of cellular phones, hand-held radios, beepers, pagers, cordless phones, and cordless microphones shall be addressed in the Standard Operating Procedures of each computer facility where classified information processing is accomplished.

The following Security Classification Guide applies. Raven Rock Mountain Complex (RRMC) Sites R, RT, & C Security Classification Guide (SCG) January 1, 2017, issued by the Commander of RRMC. Additional classification guidance will be provided by the on-site Government representative. Classified information will be handled IAW the National Industrial Security Program, DoD 5220.22-M (Change 1 March 28, 2013).

CLASSIFIED DD-254s CANNOT BE SENT VIA NIPRNET. When e-mailed, U//Controlled Unclassified Information DD-254s MUST be Encrypted.

8a. Actual Performance, Locations.

Raven Rock Mountain Complex (RRMC) - location near Blue Ridge Summit, PA 17214

10.j. CUI Information. (NOTE: 11.l. MUST also be checked and reference the CUI addendum section below). Controlled Unclassified Information including Covered Defense Information (meeting the definition of 48 CFR 252.204–7012(a)) generated and/or provided under this contract shall be marked and safeguarded as specified in DoD Instruction 5200.48 Controlled Unclassified Information (CUI). Any product containing Covered Defense Information shall be assigned the appropriate distribution statement using the criteria set forth in DoDI 5230.24 Distribution Statements on Technical Documents. All Covered Defense Information (CDI), and program Controlled Unclassified Information (CUI) data transmitted and safeguarded via electronic means shall use approved encryption. The Freedom of Information Act applies.

10.k. Other: Performance in Government Facilities. This contract requires personnel to perform work in direct support of the RRMC staff and will require individuals to work within Government controlled facilities. All contractor personnel under this contract who have access to classified information must possess a U.S. clearance. The Contract Monitor will provide security classification guidance for the performance of this contract.

In and Out Processing: This contract requires personnel to perform work in direct support of, the RRMC staff and will require individuals to obtain and maintain government issued building access cards to enable performance within Government controlled facilities. As such, all contractor personnel are required to in-process with the Administration Directorate prior to reporting for work. As a condition of this contract, all personnel issued government access cards are required to ensure the card is returned to the RRMC Security Office upon removal from the contract or termination of employment under this contract.

10.k. Other: Common Access Cards. This contract requires personnel to obtain the Government issued Common Access Card (CAC) in order to provide identification for access government computer systems and physical access to facilities. Personnel must meet and maintain investigative and adjudicative requirements specified in DoDI 5200.46, and immediately report to the GCA any issues affecting CAC eligibility. Government issued credentials are the property of the United States Government and must be returned when no longer required for performance on this contract. Return CACs to: Defense Health Agency Security Office. CACs will not be used to access information systems, facilities, or installations that are outside the performance requirements of this contract. CACs will be used only by the individual to whom it was issued and will not be used for or by any other person. The contractor will immediately notify the GCA if a CAC is lost, stolen, or otherwise missing. Replacement CACs will require the contractor employee to obtain a signed memo from the Defense Health Agency Security Office, requesting a new CAC be issued.

10.k. Other: PENTAGON FACILITY ACCESS CARD (PFAC). A PFAC may be issued when a CAC is not appropriate. The PFAC allows access to facilities only, and does not grant access to the DoD IT networks. Applicants for a PFAC must be able to favorably pass a law enforcement check of the National Crime Information Center. Government issued credentials are the property of the United States Government and must be returned when no longer required for performance on this contract. Return PFACs to: RRMC Security Office.

PFACs will not be used to access facilities, or installations that are outside the performance requirements of this contract. PFACs will be used only by the individual to whom it was issued and will not be used for or by any other person.

The contractor must immediately notify the GCA if a PFAC is lost, stolen, or otherwise missing. Replacement PFACs will require the contractor employee to obtain a signed memo from the RRMC Security Office, requesting a new PFAC be issued.

11.c. Receive, Store and Generate Classified Information Or Material. (When 11.c. is checked, blocks 11.a., 11.b., and 11.e. shall be not be checked. 11.d. will only be checked when classified hardware or material cannot be stored in a conventional two drawer GSA Security Container at the cleared facility.) This contract requires the contractor to generate or perform work in support of creating classified documents. Classified information and materials shall be protected in accordance with the policies and procedures established by DoDM

5200.01 Volumes 1-3, the National Industrial Security Program Operating Instruction (NISPOM) and all other applicable Executive

HQ003421R0003

PREVIOUS EDITION IS OBSOLETE. Page 4 of 7DD FORM 254, APR 2018

Orders. Specific classification guidance will be provided on individual tasks by the COR or CM. The contractor must ensure that applicable classification guidance and marking provisions are complied with IAW the NISPOM. In any case where classification guidance has not been provided, the contractor is to safeguard the information and seek written guidance from the COR or CM prior to release of the information to anyone except the COR or CM.

1) The contractor must restrict access to only those individuals who possess the necessary security clearance and who are actually providing services under the contract with a valid need-to-know. Further dissemination to other contractors, subcontractors, other government agencies, private individuals or organizations is prohibited unless authorized in writing by the originating agency through the

COR/CM.

2) In cases where classified information is authorized to be stored or generated at the vendor facility, the contractor must ensure each employee having access to classified material is fully aware of the special security requirements for this material and shall maintain records in a manner that will permit the contractor to furnish, on demand, the names of individuals who have had access to this material in their custody.

3) Upon completion or termination of the classified contract, or sooner when the purpose of the release has been served, the contractor will return all classified information (furnished or generated) to the source from which received unless retention or other disposition instructions are authorized in writing by the COR.

4) The contractor must designate an individual who is working on the contract as custodian. The designated custodian shall be responsible for receipting and accounting for all classified material received under this contract. This does not mean that the custodian must personally sign for all classified material. The inner wrapper of all classified material dispatched should be marked for the attention of a designated custodian and must not be opened by anyone not working directly on the contract.

5) Within 30 days after the final product is received and accepted by the procuring agency, classified intelligence materials released to or generated by the contractor, must be returned to the originating agency through the contract monitor unless written instructions authorizing destruction or retention are issued. Requests to retain material shall be directed to the CM for this contract in writing and must clearly indicate the justification for retention and identity of the specific document to be retained.

6) Classification, re-grading, or declassification markings of documentation produced by the contractor shall be consistent with that applied to the information or documentation from which the new document was prepared. If a compilation of information or a complete analysis of a subject appears to require a security classification other than that of the source documentation, the contractor shall assign the tentative security classification and request instructions from the contract monitor. Pending final determination, the material shall be safeguarded as required for its assigned or proposed classification, whichever is higher, until the classification is changed or otherwise verified.

11j. Operations Security. The contractor shall comply with OPSEC requirements specified in DoD 5220-22-M, National Industrial Security Program Operating Manual (NISPOM) and in contract addendum.

11.l. Receive, Store or Generate CUI Information. (Applies if block 10j is checked) Controlled Unclassified Information under this contract shall be safeguarded as specified in DoDI 5200.48, "DoD Controlled Unclassified Information (CUI)". Contractor will have access to unclassified information requiring safeguarding and dissemination control in alignment with specific laws, regulations, or government-wide policies (Formerly identified as For Official Use Only (FOUO), Privacy Act information, Sensitive but Unclassified, or Law Enforcement Sensitive). Contractor shall follow the safeguarding requirements in DoDI 5200.48. DoDM 5400.07, DoD Freedom of Information Act Program applies. Legacy marked U//FOUO must be protected in the same manner as CUI until it is decontrolled.

11.m. Courier authorizations. This contract requires personnel to obtain the Government issued Courier Authorization DD-2501 or letter;

couriers must complete required training; double lockable courier bags or equivalent will be used; travel via aircraft is prohibited;

classified information will not be viewed during transit; couriers will use the most direct routes to the approved destination; couriers will report any failure to safeguard classified information to their FSO and GCA Security Manager. All contractor courier personnel are required to in-process with the Security Office to obtain courier cards. All personnel issued Courier Cards are required to ensure the card is returned to the Security Office or the CAC Coordinator upon removal from the contract or termination of employment under this contract.

CUI REQUIREMENTS FOR DOD CONTRACTORS

The following procedures will be used to protect Controlled Unclassified Information (CUI) documents and materials:

1) HANDLING: Access to CUI material shall be limited to those employees needing the material to perform their duties. The CUI marking is assigned to documents and material created by a DoD User Agency. CUI is not a classification, but requires extra precautions to ensure it’s properly safeguarded and disseminated and is not released to the public without government authorization.

2) MARKING: Mark unclassified documents containing CUI: “CUI" at the top and bottom of each page, include the CUI warning box, and

HQ003421R0003

PREVIOUS EDITION IS OBSOLETE. Page 5 of 7DD FORM 254, APR 2018 the CUI Designation Indicator Block as required in DoDI 5200.48. In a classified document:

a) Mark individual paragraph containing only CUI, but not classified material by placing “(CUI)" at the beginning of the portion.

b) Mark top and bottom of each page with classified material with the highest security classification of the material on the page.

c) If the document or material contains CUI under the category of Controlled Technical Information (CTI), use of distribution statements is required. See DoDI 5200.48.

d) If a classified document contains CUI material or if the classified material becomes CUI when declassified, place the following statement on the bottom of the cover or the first page under the classification marking: “NOTE: If declassified, review the document to make sure the material is not still CUI. If it does, then it must have the appropriate safeguarding, dissemination controls, and CUI markings applied.

e) Mark other records such as computer print outs, photographs, films, tapes, or slides in accordance with DoDI 5200.48 so the receiver or viewer knows the it contains CUI material.

f) Mark a message containing material in accordance with DoDI 5200.48. Unclassified messages containing CUI material must show the abbreviation (CUI) before the text begins.

g) Ensure documents transmitting CUI material call attention to any attachments containing CUI.

h) CUI material released to a contractor by a DoD user agency must have the following statement on the front page or cover:

THIS DOCUMENT CONTAINS CUI MATERIAL AND MUST BE REVIEWED BY A GOVERNMENT REPRESENTATIVE UNDER THE REQUIREMENTS OF DODI 5200.48, DODI 5230.09, and DODI 5230.29.

3) STORAGE: During normal duty hours, place CUI material in an out-of-sight location if your work area is accessible to persons who do not have an authorized government purpose for access to the material. After normal duty hours, store CUI material to prevent unauthorized access. File with other unclassified records in unlocked files or desks when internal building security is provided and the file is marked as CUI. When there is no internal security, locked buildings or rooms usually provide adequate after hours protection. For additional protection, store CUI material in locked containers such as file cabinets, desks, or bookcases. Expenditure of funds for security containers or closed areas solely for the protection of CUI material is prohibited.

4) TRANSMISSION: CUI documents and materials may be transmitted via first class mail, parcel post or for bulky shipments-fourth class mail. Within the CONUS discussion of CUI material on the telephone is authorized if necessary for the performance of the contract and no alternative is available. Electronic transmission of CUI (voice, data, or facsimile) should be by approved secure communications systems whenever practical. If there is a fax transmission, the sender must ensure the intended receiver is available to receive it or a cover sheet will be used to allow carrying it to the final recipient to avoid unauthorized disclosure of the CUI.

5) RELEASE: CUI material shall not be released outside of the contractor’s facility except to the representative of DoD.

6) DESTRUCTION: When the CUI material no longer meets the threshold for safeguarding and dissemination, it shall be immediately decontrolled, be processed through the records management process, and destroyed by the approved methods identified in DoDI 5200.48 precluding its disclosure to unauthorized individuals by rendering it unreadable, indecipherable, and irrecoverable.

Ref 10j: Controlled Unclassified Information (CUI) generated and/or provided under this contract shall be safeguarded and marked as specified in DoD Instruction 5200.48.

Ref 11c: The contractor requires access to classified information. Any extracts must apply derivative classifications and markings consistent with the source documents. Use of "Multiple Sources" on the "Derived From" line necessitates compliance with the NISPOM, paragraph 4-208b.

Ref 11j

Ref 11l

HQ003421R0003

PREVIOUS EDITION IS OBSOLETE. Page 6 of 7DD FORM 254, APR 2018

Additional Reviewer Details:

Velynn Saunders Security Administration

[Block: 8]

[Location] [Location Code] PA 17214

[Block: 12]

DoDAAC[HQ0700] Ouid[RRMC] Release Information[Through: Director Freedom of Information & Security Review, 3100 Defense Pentagon, Rm 2C757, Washington DC 20301

Public Release Authority: Notify RRMC Deputy Commander 717-878-2771 and RRMC Security Office 717-878-2513]

Location Code/Agency Name/Address[HQ0700, RAVEN ROCK MOUNTAIN COMPLEX

RAVEN ROCK MOUNTAIN COMPLEX, 9200 AMBER DRIVE FORT DETRICK MD 21702, FORT DETRICK, MD, 21702, USA]

List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form)

NAME & TITLE OF REVIEWING OFFICIAL

Velyn Saunders

SIGNATURE

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, are established for this contract.

No Yes 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.)

OPSEC requirements are contained in the contract or addendum. All contractors performing work on this contract must have completed DoD Anti-terrorism Level 1 training within the previous 12 months. Training in on-line at https://jkodirect.jten.mil

15. INSPECTIONS

Elements of this contract are outside the inspection responsibility of the CSO.

No Yes 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)

a. GCA NAME

WHS Acquisition Directorate

b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)

HQ0034

c. ADDRESS (Include ZIP Code)

1155 Defense Pentagon

SMOC 104B

Washington, DC 20301-1155

d. POC NAME

Juan C. Gomez

e. POC TELEPHONE (Include Area Code)

+1 (571) 372-3358

f. EMAIL ADDRESS (See Instructions) juan.c.gomez.civ@mail.mil

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.

a. TYPED NAME OF CERTIFYING OFFICIAL (Last, First, Middle Initial) (See Instructions)

Blake, Kyle R

b. TITLE

Contracting Officer

BlakeKR Typewritten Text //signed//

HQ003421R0003

PREVIOUS EDITION IS OBSOLETE. Page 7 of 7DD FORM 254, APR 2018

c. ADDRESS (Include ZIP Code)

1155 Defense Pentagon

SMOC 104B

Washington, DC 20301-1155

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

HQ0034

e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.)

TBD

f. TELEPHONE (Include Area Code)

+1 (703) 545-1037

g. EMAIL ADDRESS (See Instructions) kyle.r.blake5.civ@mail.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

a. CONTRACTOR

b. SUBCONTRACTOR

c. COGNIZANT SECURITY OFFICE FOR PRIME AND

SUBCONTRACTOR

d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY

ADMINISTRATION

e. ADMINISTRATIVE CONTRACTING OFFICER

f. OTHER AS NECESSARY (If more room is needed, continue in Item 13 or on additional page if necessary.)

Contracting Officer's Representative