Tab_A5_DD_Form_254_Research_Support_Services.doc

DEPARTMENT OF DEFENSE

1. CLEARANCE AND SAFEGUARDING

CONTRACT SECURITY CLASSIFICATION SPECIFICATION

a. FACILITY CLEARANCE REQUIRED

SECRET

(The requirements of the DoD Industrial Security Manual apply to all security aspects of this effort)

b. LEVEL OF SAFEGUARDING REQUIRED

SECRET

a. PRIME CONTRACT NUMBER

Date (YYYYMMDD)

20151026

b. SUBCONTRACT NUMBER

Date (YYYYMMDD)

c. SOLICITATION OR OTHER NUMBER

DUE Date(YYYYMMDD)

NO. If Yes, complete the following:

Classified material received or generated under N62645-12-D-5026 (Preceding Contract Number) is transferred to this follow-on contract.

5. IS THIS FINAL DD Form 254?

In response to the contractor’s requested dated , retention of the identified classified material is authorized for the period of .

6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code)

a. NAME, ADDRESS, and ZIP CODE

b. CAGE CODE

c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code)

7. SUBCONTRACTOR

a. NAME, ADDRESS, AND ZIP CODE

b. CAGE CODE

c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code)

8. ACTUAL PERFORMANCE

a. LOCATION

NAVAL MEDICAL RESEARCH UNIT DAYTON

2624 Q ST

BLDG 851, AREA B

WRIGHT-PATTERSON AFB, OHIO 45433

b. CAGE CODE

N41817

c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code)

NAVAL MEDICAL RESEARCH UNIT DAYTON

2624 Q ST

BLDG 851, AREA B

WRIGHT-PATTERSON AFB, OH 45433

9. GENERAL IDENTIFICATION OF THIS PROCUREMENT

SCIENCE SUPPORT FOR NAMRU-DAYTON

10. THIS CONTRACT WILL REQUIRE ACCESS TO:

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION

CONTRACTOR’S FACILITY OR A GOVERNMENT ACTIVITY

X

b. RESTRICTED DATA

X

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION

X

d. FORMERLY RESTRICTED DATA

X

e. INTELLIGENCE INFORMATION

(1) Sensitive Compartmented Information (SCI)

X

g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER

X

f. SPECIAL ACCESS INFORMATION

X

g. NATO INFORMATION

X

I. LIMITED DISSEMINATION INFORMATION

X

I. OTHER (Specify)

k. OTHER (Specify)

DD Form 254, DEC 1999 Previous editions are obsolete

12. PUBLIC RELEASE. Any information (classified or unclassified) pertaining to this contract shall not be released for public dissemination except as provided by the Industrial Security Manual or unless it has been approved for public release by appropriate Government authority. Proposed public releases shall be submitted for approval prior to release

NAMRU-Dayton, 2624 Q St., Bldg 851, Area B, WPAFB, OH 45433 for non-SAR related material. Transmission of public release request via e-email is not authorized.

to the Directorate for Freedom of Information and Security Review, Office of the Assistant Secretary of Defense (Public Affairs)* for review. *In the case of non-DoD User Agencies, requests for disclosure shall be submitted to that agency.

13. SECURITY GUIDANCE: The security classification guidance needed for this classified 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. Add additional pages as needed to provide complete guidance.)

No 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 cognizant security office. Use Item 13 if additional space is needed.)

Ref Blk 11j: OPSEC requirements apply. The contractor will participate in the NAMRU-Dayton OPSEC Program and will comply with all WPAFB OPSEC requirements.

No elements carved out and the activity responsible for inspections. Use Item 13 if additional space is needed.)

Ref Blk 11l. Contractor performance will occur at WPAFB, OH. DSS is relieved of all inspection responsibilities for contractor performance on the installation. 88 ABW/IPD will maintain security oversight.

16. CERTIFICATION AND SIGNATURE. 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

a. TYPED NAME OF CERTIFYING OFFICIAL

b. TITLE

c. TELEPHONE

2729 R St., Bldg 837, Area B

WPAFB, OH 45433

b. SUBCONTRACTOR

e. SIGNATURE

d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION

DD Form 254 (BACK), DEC 1999