S03_Att_E_DD254_OCHSL.PDF

PDF 126 KB Posted

Attached to
Optional Control HSL Federal contract opportunity
Solicitation number
N6230619R0004
Issued by
Department of the Navy Naval Supply Systems Command

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Att_E_DD254_OCHSL

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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PREVIOUS EDITION IS OBSOLETE.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)

CurrentPage:
PageCount:
Classification: Unclassified
SerialNum:
a. Facility clearance level. Select one.: 2
b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 4
Choose Yes or No: 1
Choose Yes or No: 1
Prime: TBD
Choose Yes or No: 0
Choose Yes or No: 0
Sub:
Choose Yes or No: 0
Choose Yes or No: 0
Soli:
DueDate:
dateA: 2019-01-18
RevisionNum:
dateB:
Final:
dateC:
No: 1
No: 1
No: 0
No: 1
Yes: 0
Yes: 0
Yes: 1
Yes: 0
Enter your name here.:
ReqDated:
Enter your name here.:
Name:

TBD

Name: Moore, Jeffrey S.
Cage:
CSO: Security Manager

NAVAL OCEANOGRAPHIC OFFICE

1002 Balch Blvd Stennis Space Center, MS 39522-5001

addrow:
Removerow:
Click to delete a row:
Location: Multiple locations. See block 13.
Block9: NAVOCEANO requires the conversion of existing Hydrographic Survey Launches (HSL) to optionally controlled survey launches by which the vessel can perform all survey functions (classified and unclassified) and be fully operational in three modes: fully manned with one Coxswain and two Survey Operators, partially manned with one Coxswain, and fully autonomous with no personnel onboard.
a: 1
a: 1
a: 1
f: 0
f: 0
f: 1
b: 0
b: 0
b: 0
g: 0
g: 0
c: 0
c: 0
c: 1
h: 0
h: 0
d: 0
d: 0
d: 0
i: 0
i: 0
SCI: 0
NonSCI: 0
j: 1
j: 1
k: 1
k: 0
Enter your name here.: ISS-60
e: 1
e: 1
l: 1
m: 0
direct: 0
thru: 1
Enter your name here.: Commanding Officer, Naval Oceanographic Office
PublicAuthority: Commanding Officer, Naval Oceanographic Office
AddSig:
RemoveSig:
text: a. Issuance of this document will serve as written notice of the letting of a classified service contract. The highest level of classification for the contract is SECRET.

b. Contract performance is restricted to NAVOCEANO facilities Mississippi, USNS TAG-S vessels and other U.S. Government facilities.

c. Agency will furnish complete classification guidance for the service to be performed. Personnel Security Clearance required or requested for work assignment on this contract will be limited strictly to those required to perform the assigned function. The Contractor will be guided by Chap. 2 of the National Industrial Security Operating Manual (NISPOM) and confer with the responsible officials prior to assigning employees in-house.

d. Personnel assigned to work in-house and on USNS TAG-S vessels must comply with pertinent DoD, U.S. Navy, NASA, and SSC Security Regulations.

Items 9 and 10k: All Contractors require IT Level II (noncritical-sensitive information access) as defined in SECNAV M5510.30.

Items 10j and 11l: CUI Handling Instructions: As outlined in DoD M5200.01 Vol 4, FOUO information is not classified according to Executive Order, but is exempt from disclosure to the public under exemptions 2 through 9 of the FOIA. Do not consider or mark any other records FOUO. FOUO is not authorized as a form of classification to protect national security Interests.

attachmentsList:
AddAttachment:
ViewAttachment:
RemoveAttachment:
rep:
Sig:
Enter your name here.: Item 11j: Contractor will follow Navy (OPNAVINST 3432.1A, SECNAVINST 3070.2) and NAVOCEANO OPSEC guidance (NAVOCEANOINST 3070.2 series). Enclosure (1) of Command instruction identifies essential elements of friendly information for Naval Oceanographic Office.
GCAName: Naval Oceanographic Office
AAC: N62306
AAC: N62306
Address: Naval Oceanographic Office

1002 Balch Blvd.

Stennis Space Center, Ms. 39522-5001 Address: Naval Oceanographic Office 1002 Balch Blvd.

Stennis Space Center, Ms. 39522-5001

POCName: Daryl Vaught
Phone: 2286885547
Phone: 2286885502
Email: daryl.vaught@navy.mil
Email: jeffrey.moore5@navy.mil
Title: Information Security Specialist
Enter the date using the format DD-Mon-YYYY: 20190118

File details come from the government source that posted it.