dd254 spectral labs.pdf

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Acoustic Testing for the IM-272A/WDQ Air Particle Detector and isolation valves
Solicitation number
N0016726Q1166
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PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, APR 2018

NEEDS DD67

(Updated 20250701)

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:

August 31, 2025 The public reporting burden for this collection of information, 0704-0567, is estimated to average 36 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.)

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

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 Form 254, "DoD Contract Security Classification Specification"

CurrentPage:
PageCount:
Classification (when form is filled in) (automatically filled from previous drop-down list):
Serial Number:
1. CLEARANCE AND SAFEGUARDING - a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED

(See Instructions) - Select from drop-down list: 3

1. CLEARANCE AND SAFEGUARDING - b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/MATERIAL REQUIRED AT CONTRACTOR FACILITY - select from drop-down list: 3
3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "a. ORIGINAL (Complete date in all cases.) ": 1
3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "a. ORIGINAL (Complete date in all cases.) ": 1
2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - a. PRIME CONTRACT NUMBER (See instructions.): TBD
3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "b. REVISED (Supersedes all previous specifications.)": 0
3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "b. REVISED (Supersedes all previous specifications.)": 0
2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - b. SUBCONTRACT NUMBER:
3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "c. FINAL (Complete Item 5 in all cases.)": 0
3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "c. FINAL (Complete Item 5 in all cases.)": 0
2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER:
2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER - DUE DATE (YYYYMMDD):
3. THIS SPECIFICATION IS: (X and complete as applicable.) - a. ORIGINAL (Complete date in all cases.) :
3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - REVISION NUMBER:
3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - DATE (YYYYMMDD):
3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.):
3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.) - DATE (YYYYMMDD):
15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 1
15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 1
15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 0
15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 0
15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0
15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0
15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0
15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0
4. IS THIS A FOLLOW-ON CONTRACT? - If yes - Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract. - Enter preceding contract number.:
5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of (period) - Enter contractor's request date in format YYYYMMDD.:
E5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of - Enter period.:
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): SPECTRAL LABS, INC

15920 BERNARDO CENTER DRIVE

SAN DIEGO, CA 92127

17. CERTIFICATION AND SIGNATURES - e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.): 549W5
8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): San Diego Field Office IOFWD

11770 Bernardo Plaza Ct. Ste. 450 San Diego, CA 92127 858 385-1127

8. ACTUAL PERFORMANCE (Click button to add more locations.) - Select to add row :
8. ACTUAL PERFORMANCE - Select to remove last row:
13. SECURITY GUIDANCE - Select to delete all signature rows:
8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.):
Enter general unclassified description of this procurement.: Contract will be awarded to one contractor to improve acoustics and perform electromagnetic capability and electrical interface testing on IM-272A/WDQ Air Particle Detector (APD) units using isolation valves and the isolation valve controller. The IM-272A/WDQ monitors for airborne radioactive material on nuclear powered vessels. The IM-272A/WDQ must meet airborne and structure-borne noise limits that are CONFIDENTIAL. The contractor will be provided the noise limits and then generate test data that is CONFIDENTIAL. In addition, NNPI will also be provided to be used in the manufacture of the IM-272A/WDQ. The NNPI dictates the data output of the device.
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "b. SUBCONTRACTOR.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "b. SUBCONTRACTOR.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "b. SUBCONTRACTOR.": 0
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.) - Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0
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.) - Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 1
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0
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.) - Select for "h. REQUIRE A COMSEC ACCOUNT.": 0
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.) - Select for "h. REQUIRE A COMSEC ACCOUNT.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0
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.) - Select for "i. HAVE A TEMPEST REQUIREMENT.": 0
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.) - Select for "i. HAVE A TEMPEST REQUIREMENT.": 0
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: Select for "(1) Sensitive Compartmented Information (SCI).": 0
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: Select for "(2) Non-SCI.": 0
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.) - Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 0
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.) - Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1
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.) - Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 1
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.) - Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Enter specification for "other." (If more room is needed, continue in Item 13 or on additional page if necessary.): NNPI
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0
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.) - Select for "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.): 0
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.) - Select for "m. OTHER.": 0
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) - Select for "DIRECT": 0
12. PUBLIC RELEASE - Select for "THROUGH": 0
12. PUBLIC RELEASE - Enter specification for "through".:
12. PUBLIC RELEASE - Public Release Authority:: Not authorized.
13. SECURITY GUIDANCE - Select to add signature row:
13. SECURITY GUIDANCE - Select to remove last signature row:
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.): 10k:

(1) RD is not releasable to contractor employees who have not received a final security clearance at the appropriate level.

(2) Security Controls on the Dissemination of NNPI Received or Generated under NAVSEA Contracts of 12/1/2011(or subsequent revisions).

(3) OPNAVINST, N9210.3 Safeguarding of Naval Nuclear Propulsion Information (NNPI) of 6/7/2010 (or subsequent revisions).

(4) CG-RN-1, REV.3, CHANGES 1-20, DoE-DoD SCG for the NNPP which includes Interpretive Guidance Bulletins 1-19 (or subsequent revisions); applicable non-RD sections only

(5) Processing of NNPI on non-federal IT systems requires NAVSEA 08 authorization per OPNAVINST N9210.3, using the procedures identified in NAVSEA ltr 08B/19-03823, dated 2 August 2019.

(6) The contractor must provide a copy of subcontractor DD254s issued under this contract, where NNPI is shared, to NAVSEA 08 Security via the official shown in Item 17a of this DD254, for information.

11c: The contractor requires access to classified source data up to and including the level identified in Item 1a of this DD254. Classified material generated in support of this contract shall be classified in accordance with the source material of the Department of the Navy Security Classification Guide, which will be provided by the GCA. Automated Information Systems must be certified and accredited by the Cognizant Security Agency prior to processing classified information.

Item 11j: OPSEC requirements are additional to the requirements of the NISPOM. Prime Contractors may not impose OPSEC requirements on their subcontractors unless the GCA approves the OPSEC requirements. Information must be protected in accordance with the Operation Security Plan.

Item: 11(l). U-NNPI CUI must be protected in accordance with OPNAVINST N9210.3 and may not be stored on Non-federal AIS without written authorization of NAVSEA 08, Naval Reactors.

The following Security Classification Guides (SCGs), or subsequent revisions, apply to this contract. Subsequent revisions shall be provided by the Government Contracting Activity as Government Furnished Information and shall be executed by the Contractor at no additional cost to the government.

OPNAVINST 5513.5C (SCG ID# 05-55.2)

Classified or unclassified technical papers to be presented at a classified symposium must be approved by the NSWCCD Contracting Officer's Representative prior to the presentation. INDUSTRIAL SECURITY SOP v2 – JUNE 2018 SCGs and controlled unclassified information (e.g., FOUO, distribution statement controlled) are not authorized for public release. Therefore, they cannot be posted on a publicly accessible web-server or transmitted over the Internet unless appropriately encrypted. Request for public release cannot be transmitted via the Internet until the contractor receives final approval from NSWCCD Security Office (Code 105).

Contractor must submit a request for sharing of classified and other sensitive information between prime contracts in writing to the NSWCCD Security Office (Code 105), identified in Item 17a of this form.

Personnel designated as derivative classifiers shall receive derivative classification training prior to access from the contractor's Facility Security Officer (FSO). The FSO shall ensure personnel receive initial and biennial training during the life of this contract. Evidence of completion, training certificates or equivalent, shall be provided to the Information Assurance Manager, via the COR, no later than the individual's due date.

All classified documents must be destroyed using a National Security Agency (NSA) approved high security crosscut shredder listed on the NSA/CSS evaluated products list for high security crosscut paper shredders, or other approved method for destroying classified information.

All classified information involved in security incidents shall be retained and provided to the certifying official in Item 17a of this DD254 for classification review.

All security related issues, incidents, or requests pertaining to this contract shall be presented in writing by the contractor's FSO to the individual identified in Item 17a of this DD254. The contractor shall abide by other reporting requirements outlined in the NISPOM.

I. Forward a copy of all (existing or proposed) subcontractor(s) DD254 issued under this contract to the official shown in Item 17a of this DD254.

This DD254 is for solicitation purposes only; therefore, it must be returned to (Appropriate Industrial Security Office) to be updated before the contract DD254 can be issued to the contractor.

The Statement of Work lists the Noise Limit Specification titled, "Next Generation Air Particle Detector – Factory Vibration Acceptance Criteria; Approval with Comment (U), dated 01 Dec 2014" as an applicable document. The specification is classified CONFIDENTIAL. The Noise Limit Specification will be provided under separate correspondence.

List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form) - Click on this button to attach a file(s).:
rep:
17. CERTIFICATION AND SIGNATURES - h. SIGNATURE :
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) - a. GCA NAME:
17. CERTIFICATION AND SIGNATURES - d. AAC OF THE CONTRACTING OFFICE (See Instructions):
17. CERTIFICATION AND SIGNATURES - c. ADDRESS (Include ZIP Code):
16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - d. POC NAME:
17. CERTIFICATION AND SIGNATURES - f. TELEPHONE (Include Area Code):
17. CERTIFICATION AND SIGNATURES - g. EMAIL ADDRESS (See Instructions):
17. CERTIFICATION AND SIGNATURES - b. TITLE :
17. CERTIFICATION AND SIGNATURES - i. DATE SIGNED (See Instructions):

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