M670001-19-Q-1241_DD254.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PREVIOUS EDITION IS OBSOLETE.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:

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

BLDG I HOLCOMB BLVD

PSC BOX 20005

CAMP LEJEUNE, NC 28542

Contractors shall immediately notify the Contracting Officer and Contracting Officer Representative of any subcontracting and provide the COR with all DD254s issued to subcontractors.

The contractor must send all visit requests using JPAS. Visit requests will include the reason for visit (Other), POC, POC Phone #, Visited SMO, dates of visit Visit requests will be for the specified period of performance, but not to exceed a maximum of one year. A new visit request will be submitted annually for all long-term visitors supporting this contract. Submit visit requests to the following SMOs:

MCIEAST-MCB Camp Lejeune, NC SMO Code: 310010135 POC: Clint Thompson POC Phone: 910-451-0867

Ref 10a: Classified COMSEC material is not releasable to contractor employees who have not received a FINAL clearance at the appropriate security level. COMSEC access shall be IAW DoD 5220.22-M and MCO 5510.18B. When access is required at Government facilities, contractor personnel will adhere to COMSEC rules and regulations as mandated by Command policy and procedures. Written concurrence of the KO is required prior to subcontracting.

Ref 10j: Controlled Unclassified Information (CUI) generated and/or provided under this contract shall be safeguarded and marked as specified in DoDM 5200.01 Vol 4.

Ref 10k: Contractor requires access to Secret Internet Protocol Network (SIPRNET). A formal NATO awareness brief is required to be administered prior to access to SIPRNET. The NATO awareness briefing must be signed per the DoD 5220.22-M (NISPOM 10-706). Derivative classification is required to be completed annually prior to access to SIPRNET. The Homeland Security Presidential Directive 12 (HSPD-12) dated 27 August 2004 has established criteria for contractors who require a Common Access Card (CAC) for either physical access to a U.S. Government controlled installation or access to government information technology (IT) systems. The Government requires Personnel Security Investigations (PSI) to establish that applicants or incumbents either employed by the Government or working for the Government under contract are suitable for the job and/or are eligible for a public trust position.

Ref 11a: Contractor performance is restricted to MCIEAST-MCB CAMLEJ. Government agency or activity will provide security classification guidance for performance of this contract.

Ref 11j: Contractors are required to follow OPSEC requirements set forth in MCIEAST-MCB CAMLEJO 3070.1, dtd Oct 5, 2018.

Building 1005 Michael Road Camp Lejeune, NC 28547 Address: MCIEAST-MCB CAMLEJ Building 1005 Michael Road Camp Lejeune, NC 28547