J-5 DD254.pdf

CLASSIFICATION (When filled in): Unclassified NRL SER: 112-18

DEPARTMENT OF DEFENSE 0MB No. 0704-0567

CONTRACT SECURITY CLASSIFICATION SPECIFICATION 0MB approval expires:

(The requirements of the National Industrial Security Program (NISP) apply to all security aspects of this effort involving classified information.) 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 0MB control number.

RETURN COMPLETED FORM AS DIRECTED IN THE INSTRUCTIONS.

1. CLEARANCE AND SAFEGUARDING

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/ (See Instructions) MATERIAL REQUIRED AT CONTRACTOR FACILITY

Top Secret Secret

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

• a. PRIME CONTRACT NUMBER (See instructions.) • a. ORIGINAL (Complete date in all cases.)

DA TE (YYYYMMDD)

20190610

• b. SUBCONTRACT NUMBER b. REVISED (Supersedes all previous specifications.)

~ REVISION NO. DATE (YYYYMMDD)

c. SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMDD) I 20210427

~ PR 76-3034-18 • c. FINAL (Complete Item 5 in all cases.) DATE (YYYYMMDD)

4. IS THIS A FOLLOW-ON CONTRACT? ~ No 0 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 0 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 b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

FOR RFP PURPOSES ONLY; NOT VALID FOR NIA

ACTUAL CONTRACT A WARD NIA

7. SUBCONTRACTOR(S) (Click button if you choose to add or list the subcontractors -- but will sh/I 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)

NIA NIA

NIA

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

a. LOCA TION(S) (For actual performance, see instructions.) b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO)

NAVAL RESEARCH LABO RA TORY (If applicable, (Name, Address, ZIP Code, Telephone required; Email Address optional)

4555 OVERLOOK A VENUE, SW

see Instructions.)

WASHINGTON, DC 20375

NIA

NIA

a. LOCATION(S) (For actual performance, see instructions.) b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (If applicable, (Name, Address, ZIP Code, Telephone required; Email Address optional)

TBD AFTER AW ARD

see Instructions.}

TBD

TBD

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

SCIENTIFIC, ENGINEERING AND RELATED SUPPORT FOR D EVELOPMENT, TEST AND VALIDATION OF SPACE FLIGHT

INSTRUMENTATION.

DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE.

CLASSIFICATION (When filled in): Unclassified

NRL SER: 112-18

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

[gj a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION

[gj b. RESTRICTED DATA

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

[gj d. FORMERLY RESTRICTED DATA

e. NATIONAL INTELLIGENCE INFORMATION:

[g] (1) Sensitive Compartmented Information (SCI)

0 (2) Non-SCI

• f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION l'vl g. NORTH ATLANTIC TREATY ORGANIZATION

161 (NATO) INFORMATION

0 h. FOREIGN GOVERMENT INFORMATION

• i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

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

D k. OTHER (Specify) (See instructions.)

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

0 ACTIVITY

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

See instructions.)

0 b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY l'vl c. RECEIVE, STORE, AND GENERATE CLASSIFIED

161 INFORMATION OR MATERIAL

0 d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE

• e. PERFORM SERVICES ONLY

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

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

TERRITORIES

12. PUBLIC RELEASE

g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE

0 TECHNICAL INFORMATION CENTER (DTIC) OR OTHER

SECONDARY DISTRIBUTION CENTER

• h. REQUIRE A COMSEC ACCOUNT

0 i. HAVE A TEMPEST REQUIREMENT

[gj j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

0 k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE

I. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED

INFORMATION (CUI).

(DoD Components: refer to DoDM 5200.01 , Volume 4 only for specific CUI protection requirements. Non-DoD Components: see instructions.)

[gj m. OTHER (Specify) (See instructions.)

STE SECURE VOICE CAPABILITY {NRL ONLY)

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)

D DIRECT [g] THROUGH (Specify below) I Public Release Authority :

13. SECURITY GUIDANCE

PUBLIC RELEASE OF ANY INFORMATION, TO INCLUDE

SCI, CONCERNING THIS CONTRACT IS NOT AUTHORIZED.

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 cotrespondence, 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.)

***UPDATED SECURITY STATEMENTS IN BLOCK 13 AND SECURITY POCs***

1. Contractor Sensitive Compartmented Information (SCI) work/access is granted at the cleared U.S. Government/DoD facilities only.

Contractors requiring SCI access must be US citizens, possess a final DoD granted TOP SECRET security clearance, based on a favorably adjudicated DoD Tier 5 investigation; be ICD 704 eligible, and be indoctrinated for the applicable SCI compartments prior to access .

Names of contractor personnel requiring SCI access will be submitted to the SCI POC named in para 13. Contractor personnel requiring

DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE.

CLASSIFICATION (When filled in) : Unclass ifi ed access to non-SCI classified material or unclassified mformat1on at NRL; or requmng non-SCI access at anothercTeared U.S. Government/ DoD facility must be a US citizen; have at least a favorably adjudicated DoD Tier 3 investigation and a final SECRET clearance, and have prior approval of the COR and SCI POC named in para 10 to work on this contract. The number ofDCSA requested clearances is limited to 6.

2. NATO briefings required . NATO access authorized at SECRET level only. Initial NATO briefings must be within a 5 year scope of the completed investigation. Visit request and a copy of NATO indoctrination must be sent to Code 123 1 prior to access . NATO briefing date must be within the current year. Annual refresher briefings for NATO access are required . A copy of the signed annual re-briefings must be forwarded to NRL Code 1231 annually. NATO access is authorized at cleared US Government/DoD facilities only.

3. Foreign Nationals are not authorized to work on this contract.

4 . Classified information or Controlled Unclassified Information (CUI), such as Proprietary, Privacy Act or FOUO, etc., information associated with this contract, must be handled/controlled JAW DoD 5200.48 .

5. The contractor will be required to generate, receive or store SECRET material at the contractor's facility during performance of this contract. Contractor must return al l classified information generated in conjunction with this contract to the COR named below at the completion of this contract.

6. All contractors (including subcontractors) identified in the Statement of Work shall supplement their current security practices by requiring any personnel involved in executing the contract to complete Government-sponsored and administered Operations Security (OPSEC) training, OPSE-130 I and any OPSEC guidance that may pertain to the project.

7. Contractor personnel performing any function designated as a component of the Cyber Security Work Force (CSWF), and/or having privileged user access to NRL information systems and/or networks will require background investigations as specified in SECNAV M-5510.30. Contractors with privileged access shall meet the training and certification requirements specified in SECNA V M-5239.2. A submitted DoD Tier 5 Investigation is required for all with privileged access . Personnel performing these duties must be identified as such on all badge and visit request submissions.

8. Restricted Data (RD)/Formerly Restricted Data (FRD)/Critical Nuclear Weapons Design Information (CNWDI) briefings required. A copy of the signed annual re-briefings must be forwarded to NRL Code 1231 annually. NATO, RD/FRD/CNWDl access is authorized at cleared US Government/DoD facilities only.

9. Visit requests and Need-to-know certifications are required for all personnel on this contract. Visit requests must include full name, SSN, contract number, clearance level , date of closed investigation and should state if IT access is required . Visit requests for OTHER U.S.

Government/DoD contractor facilities will be processed through the contractor FSO. Authorized work locations for this contract are listed below.

I 0. The prime contractor will forward a copy of all proposed subcontracts and task orders to the COR named in paragraph 13, related to this contract, regardless of classification, for review, approval and coordination with the official named in block 16d below. All subcontracts must be approved in writing, by the official named in block 16d below prior to the start of work.

11. Contractors issued a DoD interim secret security clearance may ONLY work on unclassified tasks as outlined in the SOW. Unclassified IA or IT positions are NOT authorized with a DoD issued interim secret clearance. Contract Facility Security Officers (FSOs), and/or NRL CORs, are required to report immediately to Code 1230 any derogatory information regarding a contractor holding an interim Secret clearance, either on- or off-site. FSOs and NRL CORs shall also notify Code 1230 when a contractor's interim or final clearance has been declined or revoked.

12. COMSEC briefings required and processed through NRL COMSEC, Code 1222, (202) 767-7481.

13 . The NRL COR for this contract is David Siskind, NRL Code 7632, (202) 767-0928. The NRL SCI point of contact is Oscar Barrow, NRL Code 1232, (202) 767-0862. The Security point of contact for this contract is the official named in block 16d.

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

14. ADDITIONAL SECURITY REQUIREMENTS

NAME & TITLE OF REVIEWING OFFICIAL

Oscar A. Barrow, NRL SSO

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

D No cg] Yes

DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE.

CLASSIFICATION (When filled in): Unclassified

SIGNATURE

BARROW.OSCA :;J~~~;~~:R.A ll 812JJ32 R.A.1181233326 ~,,'" 2021.0,.0,os"' '" -0,·oo·

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.)

SEE SCI ADDENDEM ATTACHED. SEE BLOCK 13, PARAGRAPH 6 .

15. INSPECTIONS

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

0 No cg] 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.)

PUBLIC RELEASE OF ANY INFORMATION, TO INCLUDE SCI , CONCERNING THIS CONTRACT IS NOT AUTHORIZED.

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)

a. GCA NAME c. ADDRESS (Include ZIP Code) d. POC NAME

4555 OVERLOOK A VENUE, SW JAMES D. MILLARD

NAVAL RESEARCH LABORATORY WASHINGTON, DC 20375 e. POC TELEPHONE (Include Area Code)

b. ACTIVITY ADDRESS CODE (AAC) OF THE + 1 (202) 767-2576 CONTRACTING OFFICE (See Instructions) f. EMAIL ADDRESS (See Instructions)

N00173 dave. millard@ nrl.navy.mil

17. CERTIFICATION AND SIGNATURES

Security requirements stated he rein 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) d. AAC OF THE CONTRACTING OFFICE h. SIGNATURE (See Instructions) (See Instructions) MILLAR Digitally signed

MILLARD, JAMES D. NOOI 73 by

D.JAME MILLARD.JAM

b. TITLE e. CAGE CODE OF THE PRIME CONTRACTOR ES.D. I 04262307

(See Instructions.) S.D. 1O421

BRANCH HEAD-INFORMATION SECURITY

623071

Date: 202 1.05.06 13:32:54 -04'00' c . ADDRESS (Include ZIP Code) f. TELEPHONE (Include Area Code) i. DA TE SIGNED

4555 OVERLOOK A VENUE, SW + I (202) 767-2576

(See Instructions)

WASHINGTON, DC 20375 g . EMAIL ADDRESS (See Instructions) dave .millard@ nrl .navy.mil

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

cg] a. CONTRACTOR cg] f. OTHER AS NECESSARY (If more room is needed, continue in Item 13 oron additional page if necessary.)

0 b. SUBCONTRACTOR 1222, 1231 , 1232,7602, 7632 cg] c. COGNIZANT SECURITY OFFICE FOR PRIME AND

SUBCONTRACTOR

0 d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY

ADMINISTRATION

cg] e. ADMINISTRATIVE CONTRACTING OFFICER

DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE. Page 4 of 4

NRL SER: 112-18 CLASSIFICATION (When filled in): Unclassified

U.S.NAVAL

ESEARC

LABORATORY

FROM:

TO:

SUBJ:

ENCL:

Naval Research Laboratory Special Security Officer

David Siskind , Code 7632

PR 76-3034-18

(1) IRCCO approval letter

1232-008-18 June 14, 2019

1. The subject contract has been approved for SCI access. The letter states that subject submission does not meet their criteria and may be handled thru NRL contracts.

2. Please keep attached documentation for your records. A copy of the 00254 will be sent to contracts. Make sure I am notified when the contract is let - the 00254 will have to be modified.

3. Nominations for SCI accesses should be sent to Code 1232.

4. If you have any questions, please call me on 202-767-0469 or email:

mary.neuland@nrl.navy.mil.

Naval Research Laboratory Special Security Office - Code 1232

U.S. Naval Resea rch Laboratory

4555 Overlook Ave. S.W., Was hington, DC 20375 www.nrl .navy.mil

NEU LAND M Digitally signed by

' NEULAND.MARY.AN

ARY.ANNE.1 NE.1229312100

2293121 OO Da_te: _2019.0,6.1,4

M N I 0p.57.11 -0400 ary eu ana

NRL ASSO

Giancoli, An2ela

From:

Sent:

To:

Subject:

Hi Angela!

Henley, James Friday, September 14, 2018 9:39 AM Giancol i, Angela RE: OPSEC Review

I do not see any OPSEC concerns with 76-3034-18 (figured I should put the number on here since you 're shooting me multiple sows)

You don't have too much fun this weekend yourself! I'm just glad its not going to be a flood now

James T. Henley Code 1211 Naval Research Laboratory (202 )404-64 73

-----Original Message---- From: Giancoli, Angela Sent: Wednesday, September 12, 2018 3:40 PM To: Henley, James <james.henley@nrl.navy.mil> Subject: OPSEC Review

James, Sorry it has been a busy day lol. Here is another one. Let me know if you need anything additional.

Thanks, Angela M . Giancoli Code 1230 Information Security & Special Programs Naval Research Laboratory Washington, DC 20375-5320 Phone: 202-767-7625 Fax: 202-767-3874