Attachment_04_AMEND_1_DD254_signed.pdf

CLASSIFICATION (When filled in): Unclassified

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AEM LiveCycle Designer DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE. Page 1 of 4

AEM LiveCycle Designer

DD 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:

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

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED

(See Instructions)

Secret

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

None (See instructions)

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

a. PRIME CONTRACT NUMBER (See instructions.)

Request For Performance, Not Valid for Performance

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

N00421-18-R-0044

DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20180821

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

Request For Performance, Not Valid for Performance

b. CAGE CODE

N/A

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

N/A

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) Add Row Remove last Row Delete All Rows

a. NAME, ADDRESS, AND ZIP CODE

b. CAGE CODE

N/A

8. ACTUAL PERFORMANCE (Click button to add more locations.) Add Row Remove last Row Delete All Rows

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

NAWCAD Patuxent River, MD NAWCAD Joint Base McGuire Dix Lakehurst, NJ NAWCWD China Lake, CA NAWCAD Point Mugu, CA

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

N/A

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

FRC Cherry Point, NC FRC Jacksonville, FL FRC, North Island, CA Tinker AFB, OK

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

N/A

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Lifecycle support of weapons system logistics product data/publications and or technical manuals.

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DD 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.)

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

m. OTHER (Specify) (See 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)

DIRECT THROUGH (Specify below)

Transmissions by non-secure facsimile or E-mail is NOT authorized (by Prime or subcontractor(s))

Public Release Authority:

Submit ALL Public Releases to: AIR-6.8.5.1

13. SECURITY GUIDANCE Add Signature Remove last Signature Delete All Signatures

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.)

Technical papers, briefings, presentations, either classified or unclassified to be presented at classified symposia must be submitted to AIR-7.4.1 for approval prior to presentation. Unclassified material submitted for public release (that is not to be presented at classified symposia) shall be forwarded for review prior to release as stated in item 12 above. All controlled unclassified and classified technical information shall be appropriately marked with distribution statements as specified in DoDI 5230.24 (Distribution Statements on Technical Documents) http://www.dtic.mil/whs/directives/corres/pdf/523024p.pdf.

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Determination of need-to-know in connection with a classified visit is the responsibility of the individual/host who will disclose the classified information.

All contracts with non-Sensitive Compartmented Information and Non-Compartmented work that may reveal mission-related information of a sensitive activity or sensitive operation should be routed to the NAVAIR STILO for approval.

All instances of loss, compromise and electronic spillage of classified or controlled unclassified information shall be reported to the COR, TPOC, and Government Security Office within 24 hours of the incident occurring.

10.g –To facilitate potential access to NATO classified information, to include NATO accredited SIPRNet terminals, all DoD military, civilian, and contractor personnel who are briefed on their responsibilities for protecting U.S. classified military information, shall also be briefed on the requirements for protecting NATO information, per Deputy Under Secretary of Defense Policy Security Memo of 5 Dec 01.

Written concurrence of the Contracting Officer/Technical Point of Contact, identified in Block 16, is required prior to subcontracting.

10.j/11.l – Controlled Unclassified Information including For Official Use Only and 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 DoDM 5200.01 (DoD Information Security Program: Controlled Unclassified Information (CUI)) Vol. 4 (enclosure 3 pages 11-18) available at https:// fas.org/sgp/othergov/dod/index.html. 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); and have this statement displayed per DoDI 5230.24, Enclosure 3-4.

All For Official Use Only (FOUO), Covered Defense Information (CDI), and program Controlled Unclassified Information (CUI) data transmitted and safeguarded via electronic means shall use approved encryption. The Contractor shall ensure that when transmitting FOUO/CDI, over non-secure e-mail (e.g. not connected to the Navy Marine Corps Intranet through Broadband Unclassified Remote Access System / Virtual Private network), those transmissions are encrypted using Department of Defense Public Key Infrastructure (PKI), or an approved DoD External Certificate Authority, in accordance with Public Key Infrastructure & Public Key Enabling, DoDI 8520.02, 24 May 2011.

11.a – All classified information/material shall be provided by the contractor facility or Government Contracting Activity (GCA) and safeguarded at the approved actual performance site.

Specific Security Classification Guidance (SCGs), to include subsequent upgrades/revision(s), applying to classified performance on this contract, shall be provided by the Contracting Officer Representative or Technical Point of Contact, identified in Blk 16, as Government Furnished Information (GFI); and shall be executed by the Contractor without obligation to modify this DD Form 254. If additional security classification is required, contact the COR identified in Blk 16d.

11.g – To use DTIC services, the contractor must register for an account at http://www.dtic.mil/dtic/registration/contractors/index.html.

11.j – OPSEC: While performing aboard NAVAIR or other U.S. military sites, the contractor shall comply with the provisions of OPNAVINST 3432.1, the local Command/Facility 3432 Instruction Series (OPSEC), as well as any procedures identified in Program- Specific Operations Security Plans and Program Protection Plans (PPP) as applicable. The contractor shall comply with any and all additional OPSEC security plans and requirements of the Hosting Command. All applicable OPSEC Plans will be provided by TPOC identified in Block 16. The prime contractor is responsible for subcontractor implementation of Operations Security.

If additional security classification assistance is required, please contact the TPOC listed in block 16d.

************************************END DD254 ADDITIONAL DATA SHEET************************************

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

Add Attachment View Selected Attachment Remove Selected Attachment

NAME & TITLE OF REVIEWING OFFICIAL

SIGNATURE

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AEM LiveCycle Designer

DD FORM 254, APR 2018

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 in contract

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

Naval Air Warfare Center Aircraft Division

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

N00421

c. ADDRESS (Include ZIP Code) Building 446 Floor 1, Room 112B Patuxent River, MD 20670

d. POC NAME

Ms. Carol Norris

e. POC TELEPHONE (Include Area Code)

+1 (301) 757-9322

f. EMAIL ADDRESS (See Instructions) carol.a.norris@navy.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)

Davis, Mark A.

b. TITLE

Contracting Officer Representative for Security (COSR)

c. ADDRESS (Include ZIP Code) Commander, Naval Air Warfare Center Aircraft Division Bldg. 2272, Rm. 074, Attn: 7.4.1 Security Patuxent River, MD 20670-1547

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

N00421

e. CAGE CODE OF THE PRIME CONTRACTOR

(See Instructions.)

f. TELEPHONE (Include Area Code)

+1 (301) 342-6045

g. EMAIL ADDRESS (See Instructions) mark.a.davis@navy.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.)

See Item 13

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)

Request For Performance, Not Valid for Performance Name:

N/A

N/A

CSO:

N/A

CSO:

N/A

CSO:

N/A

NAWCAD Patuxent River, MD NAWCAD Joint Base McGuire Dix Lakehurst, NJ NAWCWD China Lake, CA NAWCAD Point Mugu, CA Location: FRC Cherry Point, NC FRC Jacksonville, FL FRC, North Island, CA Tinker AFB, OK

See Item 13

Determination of need-to-know in connection with a classified visit is the responsibility of the individual/host who will disclose the classified information.

All contracts with non-Sensitive Compartmented Information and Non-Compartmented work that may reveal mission-related information of a sensitive activity or sensitive operation should be routed to the NAVAIR STILO for approval.

All instances of loss, compromise and electronic spillage of classified or controlled unclassified information shall be reported to the COR, TPOC, and Government Security Office within 24 hours of the incident occurring.

10.g –To facilitate potential access to NATO classified information, to include NATO accredited SIPRNet terminals, all DoD military, civilian, and contractor personnel who are briefed on their responsibilities for protecting U.S. classified military information, shall also be briefed on the requirements for protecting NATO information, per Deputy Under Secretary of Defense Policy Security Memo of 5 Dec 01. Written concurrence of the Contracting Officer/Technical Point of Contact, identified in Block 16, is required prior to subcontracting.

10.j/11.l – Controlled Unclassified Information including For Official Use Only and 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 DoDM 5200.01 (DoD Information Security Program: Controlled Unclassified Information (CUI)) Vol. 4 (enclosure 3 pages 11-18) available at https://fas.org/sgp/othergov/dod/index.html. 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); and have this statement displayed per DoDI 5230.24, Enclosure 3-4.

All For Official Use Only (FOUO), Covered Defense Information (CDI), and program Controlled Unclassified Information (CUI) data transmitted and safeguarded via electronic means shall use approved encryption. The Contractor shall ensure that when transmitting FOUO/CDI, over non-secure e-mail (e.g. not connected to the Navy Marine Corps Intranet through Broadband Unclassified Remote Access System / Virtual Private network), those transmissions are encrypted using Department of Defense Public Key Infrastructure (PKI), or an approved DoD External Certificate Authority, in accordance with Public Key Infrastructure & Public Key Enabling, DoDI 8520.02, 24 May 2011.

11.a – All classified information/material shall be provided by the contractor facility or Government Contracting Activity (GCA) and safeguarded at the approved actual performance site.

Specific Security Classification Guidance (SCGs), to include subsequent upgrades/revision(s), applying to classified performance on this contract, shall be provided by the Contracting Officer Representative or Technical Point of Contact, identified in Blk 16, as Government Furnished Information (GFI); and shall be executed by the Contractor without obligation to modify this DD Form 254. If additional security classification is required, contact the COR identified in Blk 16d.

11.g – To use DTIC services, the contractor must register for an account at http://www.dtic.mil/dtic/registration/contractors/index.html.

11.j – OPSEC: While performing aboard NAVAIR or other U.S. military sites, the contractor shall comply with the provisions of OPNAVINST 3432.1, the local Command/Facility 3432 Instruction Series (OPSEC), as well as any procedures identified in Program-Specific Operations Security Plans and Program Protection Plans (PPP) as applicable. The contractor shall comply with any and all additional OPSEC security plans and requirements of the Hosting Command. All applicable OPSEC Plans will be provided by TPOC identified in Block 16. The prime contractor is responsible for subcontractor implementation of Operations Security.

If additional security classification assistance is required, please contact the TPOC listed in block 16d.

************************************END DD254 ADDITIONAL DATA SHEET************************************ text:

Patuxent River, MD 20670 Address: Commander, Naval Air Warfare Center Aircraft Division Bldg. 2272, Rm. 074, Attn: 7.4.1 Security Patuxent River, MD 20670-1547