J1 - DD254_Approved.pdf

CLASSIFICATION (When filled in): Unclassified NRL SER: 034-21

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 tt1is 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 0 MB 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 None (Sec instructions)

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.)

DATE (YYYYMM00)

a. ORIGINAL (Complete date in all cases.)

20210601

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

• REVISION NO. DA TE (YYYYMM0D)

c. SOLICITATION OR OTHER NUMBER DUE DA TE (YYYYMM0D)

~ N00 173-21-R-RJ02 • c . FINAL (Complete Item 5 in all cases.) DA TE (YYYYMM00)

4. IS THIS A FOLLOW-ON CONTRACT? 0 No [gJ Yes If yes, complete the following:

Classified material received or generated under N00 173-16-F-6402 (Preceding Contract Number) is transferred to this follow-on contract.

5. IS THIS A FINAL DD FORM 254? 0 No D 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 Commercia l 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 V AUD FOR

TBD

ACTUAL CONTRACT AWARD TBD

1. SUBCONTRACTOR(S) (Click button if you choose to add or list the subcontractors -- but will sfill require a separate 00 Fonn 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 petfonnance, see instructions.) b. CAGE CODE c. COGNIZANT SECURITY OFFICE{S) {CSO)

NAVAL RESEARCH LA BORA TORY (ff applicable, (Name, Address, ZIP Code, Telepl1one required; Email Address optional)

4555 OVERLOOK A VENUE, SW

see lnstruclions.)

WASHINGTON, DC 20375

NIA

NIA

a. LOCATION(S) (For actual petfonnance, see instructions.) b. CAGE CODE c . COGNIZANT SECURITY OFFICE{S) {CSO)

VARIOUS NRL FIELD SITE LOCATIONS TO BE (ff applicable, (Name, Address, ZIP Code, Telephone required; Email Address optional)

DETERMJNED AFTER AW ARD

see lr1structions.}

NIA

NIA

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

SPACE SYSTEMS DEVELOPMENT AND ENGrNEERING SER VICES .

DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE. Page 1 of 4

NRL SER: 034-21 CLASSIFICATION (When filled in) : Unclassified

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply Provide details in Blocks 13 or 14 as set for/11 in the instructions.)

[gj a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION

0 b. RESTRICTED DATA

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

0 d. FORMERLY RESTRICTED DATA

e. NATIONAL INTELLIGENCE INFORMATION:

[gj (1) Sensitive Compartmented Information (SCI)

[gj (2) Non-SCI

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

IL:,,! (NATO) INFORMATION

0 h. FOREIGN GOVERMENT INFORMATION

• i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

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

0 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

[gj ACTIVITY (Applicable only if there is no access or storage required at contractor facility See ins/ructions.)

0 b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY

• c. RECEIVE, STORE, AND GENERATE CLASSIFIED

INFORMATION OR MATERIAL

[gj d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE

0 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 [gj TECHNICAL INFORMATION CENTER (DTIC) OR OTHER

SECONDARY DISTRIBUTION CENTER

0 h. REQUIRE A COMSEC ACCOUNT

0 i. HAVE A TEMPEST REQUIREMENT

[gj j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

[gj 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 specinc CUI protection requirements. Non-DoD Components: see instn,clions.)

D m. OTHER (Specify) (See ins/ructions.)

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)

0 DIRECT [gj THROUGH (Specify below) I Public Release Authority:

13. SECURITY GUIDANCE

PUBLIC RELEASE OF ANY INFORMATJON, 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 classined effort. Attach, or forward under separate correspondence, any documents/guides/ex tracts referenced herein. The neld will expand as text is added. When removing any expanded text area, use delete key or backspace key, then click out of the text neld for it to shrink after the text has been deleted. Also allows for up lo 6 internal reviewers to digitally sign. See instructions. for additional guidance or use of //1e fillable PDF.)

I. Contractor Sensitive Compatimented 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 12. Contractor personnel requiring access to non-SCI classified material or unclassified information at NRL; or requiring non-SCI access at another cleared U.S. Government/ DoD facility must be a US citizen; have at least a favorably adjud icated DoD Tier 3 investigation and a final SECRET clearance, and have

DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE.

CLASSIFICATION (When filled in) : Unclassified

NRL SER: 034-21

prior approval~oTTfie COR anaSCI POC 11ai11eOm~pa1·a 12 to worl<on1hfrcontract. The numoerof DCSA~requested clearances is limited to 30.

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 1231 prior to access. NATO briefing date must be within the current year. Annual refresher briefings for NATO access are required. A copy of the s igned 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 thi s contract.

4. Controlled Unclassified Information (CUf) information associated with this contract must be handled/contro lled IA W DoD 5200.48.

5. Contractor will NOT be required to receive, generate, or have custody of CLASSIFIED material at the contractor's facility.

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

7. 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-1 301 and any OPSEC guidance that may pertain to the project.

8. Contractor personnel performing any ti.mction 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 SECNA V M-5510.30 . Contractors with privileged access shall meet the training and certification requirements specified in SECNAV 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.

9. Vis it 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 I 2, 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 unclassi fied tasks as outlined in the SOW. Unclassified LA or 1T 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 CO Rs shall also notify Code 1230 when a contractor' s interim or final clearance has been declined or revoked.

12. The NRL COR for this contract is Danielle Gilason, NRL Code 8145, (703) 55 l-J 975. 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 Barrow, NRL SSO

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

SIGNATURE

BARROW.OSCA :;i~~i;i:;~~~A ll81 2Jll2 R.A. I 181233326 ;:,,,". 2ow 1•.o• " ''"' -0, ·oo·

D No rgJ 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 ii to shrink after the text has been deleted.

(See instructions for additional guidance or use of the fillable PDF.)

SEE BLOCK 13, PARAGRAPH 7. SCI ADDENDUM WILL BE INCLUDED AFTER AWARD.

15. INSPECTIONS

DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE.

CLASSIFICATION (When filled in): Unclassified

NRL SER: 034-21

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

0 No [gJ 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.)

NRL SIO HAS EXCLUSIVE SECURITY RESPONSIBILITY FOR SCI CLASSIFJED MATERIAL STORED, RELEASED OR

DEVELOPED UNDER THIS CONTRACT.

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

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

MATTHEW J . SAAM

NAVAL RESEARCH LABORATORY

4555 OVERLOOK A VENUE, SW

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

+ I (202) 767-2521 b, ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)

N00l 73

17. CERTIFICATION AND SIGNATURES

f. EMAIL ADDRESS (See Instructions) m atthew .saam@n rl .navy. mi I

Security requirements stated herein are complete and adequate for sa feguarding the classified information to be re leased or generated under this classified effort. All questions shall be referred to the official named below. Upon digitally signing Item 17h, no changes ca n be made as the form will be locked .

a, TYPED NAME OF CERTIFYING OFFICIAL (Last, First, Middle Initial) I d. AAC OF THE CONTRACTING OFFICE I h, SIGNATURE (See Instructions) (See Instructions)

SAAM, MATTHEW J N00 173

SAAM.M ~:gitall y signed t------- -------- ---- ----------1-------- ---- - - - ------IATTHEW. SAA M.MATrH

b. TITLE

SECTION HEAD- TNFORMA TTON SECURITY

c. ADDRESS (Include ZIP Code)

4555 OVERLOOK A VENUE, SW

WASHINGTON, DC 20375

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

[gj a. CONTRACTOR

• b. SUBCONTRACTOR l'v1 c, COGNIZANT SECURITY OFFICE FOR PRIME AND

161 SUBCONTRACTOR

• d. U.S, ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY

ADMINISTRATION

[gj e, ADMINISTRATIVE CONTRACTING OFFICER

e. CAGE CODE OF THE PRIME CONTRACTOR EW.JAMES.138 (See Instructions.) JAMES .l 3 4656 109 f , TELEPHONE (Include Area Code)

+1 (202) 767-252 1

g. EMAIL ADDRESS (See Instructions) matthew ,saam@nrl . navy.mi I

84656109 Date: 202 1 06.09 11 :00: 15 -04'00'

i. DATE SIGNED (See Instructions)

20210609 l'v1 f, OTHER AS NEC ESSARY (If more room is needed, continue in Item 13 or on 161 additional page if necessary.)

1222, 1231 , 1232, 8102, 8145

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

NRL SER: 034-21 CLASSIFICATION (When filled in): Unclassified

6. Acronyms

HW: Hardware

NCST: Naval Center for Space Technology

OCI: Organizational Conflict of Interest

PI: Principal Investigator

R&D: Research and Development

SAP: Special Access Programs

SSDD: Space Systems Development Department

STD: Standards

S&T: Science and Technology

SW: Software

TDM: Technical Directive Memoranda

Page 8 of9