RFP_Attachment_3_DD_Form_254.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)

20160404

b. SUBCONTRACT NUMBER

Date (YYYYMMDD)

N62645-16-R-0038 DUE Date(YYYYMMDD)

NO. If Yes, complete the following:

Classified material received or generated under W911QY-11-D-0058 0003 (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

b. CAGE CODE

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

9. GENERAL IDENTIFICATION OF THIS PROCUREMENT

Capability-Based Medical Modeling and Simulation for the Naval Health Research Center

10. THIS CONTRACT WILL REQUIRE ACCESS TO:

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION

CONTRACTOR’S FACILITY OR A GOVERNMENT ACTIVITY

x

b. RECEIVE CLASSIFIED DOCUMENTS ONLY x

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION

d. FORMERLY RESTRICTED DATA

x

e. INTELLIGENCE INFORMATION

e. PERFORM SERVICES ONLY x

(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

I. HAVE TEMPEST REQUIREMENTS

x

h. FOREIGN GOVERNMENT INFORMATION

x

I. LIMITED DISSEMINATION INFORMATION

x

I. OTHER (Specify) AFFARS 5352.204-9000, VGSA Applies.

Require access to SIPRNET at the contractor’s facility.

Process Classified AIS.

X

k. OTHER (Specify)

SIPRNET

X

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

Release of classified information 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.)

ELIGIBILITY FOR ACCESS TO SECRET IS PART OF REQUIREMENTS FOR THIS CONTRACT. CLASSIFIED AIS PROCESSING AT THE CONTRACTOR'S FACILITY MUST BE PERFORMED ON A COMPUTER ACCREDITED AT THE LEVEL OF INFORMATION TO BE PROCESSED. CONTRACTOR MUST ESTABLISH AND MAINTAIN A CLASSIFIED ANALYSIS ENVIRONMENT TO PERFORM THE SCOPE OF WORK ASSOCIATED WITH THIS EFFORT. ACCESS TO SIPRNET AT THE CONTRACTOR’S FACILITY IS A REQUIREMENT FOR THIS EFFORT.

REFERENCES: NATIONAL INDUSTRIAL SECURITY PROGRAM OPERATING MANUAL (NISPOM), DOD 5220.22M

PERIOD OF PERFORMANCE: 60 MONTHS FROM DATE OF AWARD.

14. ADDITIONAL SECURITY REQUIREMENTS. Requirements, in addition to ISM requirements, 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 cognizant security office. Use Item 13 if additional space is needed.)

15. INSPECTIONS. Elements of this contract are outside the inspection responsibility of the cognizant security office. (If Yes, identify specific areas or

elements carved out and the activity responsible for inspections. Use Item 13 if additional space is needed.)

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

Victor Hernandez

b. TITLE Contracting Officer’s Representative (COR)

c. TELEPHONE

(619) 524-9832

Naval Health Research Center

140 Sylvester Road

San Diego, CA 92106

b. SUBCONTRACTOR

e. SIGNATURE

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

DD Form 254 (BACK), DEC 1999