Attachment 9 - DD 254.pdf

CLASSIFICATION (When filled in): Unclassified

19-021

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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)

Top 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.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

N65236-18-R-0081

DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20190221

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

THIS DD254 IS FOR SOLICITATION PURPOSES

ONLY. A PRIME CONTRACT DD254 WILL BE

PROVIDED UPON CONTRACT AWARD.

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

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

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.)

NAVINFOWARCEN Atlantic, Charleston SC

***CONTINUED IN BLOCK 13***

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

N/A

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

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Satellite Communication (SATCOM) Capability-Base (CB) In-Service Engineering Activity (ISEA) Support

19-021

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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.)

Naval Nuclear Propulsion Information (NNPI); SIPRNet

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)

Commanding Officer, Naval Information Warfare Center Atlantic, PO Box 190022, North Charleston, SC29419-9022

Public Release Authority:

NO PUBLIC RELEASE OF INFORMATION

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.)

1. Contractors may have access to information or material which is classified up to the TOP SECRET level per the Wideband Satellite Communications (SATCOM) Assured Command Control (AC2) Modulation/Demodulation (Modem) Security Classification Guide Version: v1.1 of 20 OCT 2017; Originator: PMW/A 170. DISA Circular 300-115-3; Subj: (U) Communication Security (U) Defense Information System Network (DISN) Secret Internet Protocol Routing Network (SIPRNet) Security Classification Guide.

2. Those contractors will require a TOP SECRET security clearance per SECNAV M-5510.36, SECNAV M-5510.30 and DoD 5220.22-M.

Additional security guidance will be provided by the NAVINFOWARCEN Atlantic Security Manager.

3. Only persons actually performing classified tasks on this contract shall be required to obtain and maintain security clearances per DoD 5220.22-M.

4. Documentation obtained for use with this contract shall not be used for any other purpose unless prior authorization has been obtained from NAVINFOWARCEN Atlantic.

5. Contractors will understand and practice sound OPSEC principles per OPNAVINST 3432.1 and SPAWARSYSCENINST 3432.1 and ensure that employees receive OPSEC training by the government upon initial assignment and annually thereafter.

6. Controlled Unclassified Information (CUI), such as For Official Use Only (FOUO) will be handled and safeguarded per DoDM 5200.01, 19-021

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Volume 4.

7. The contractor shall not downgrade, declassify, or destroy any classified documentation used with this contract. All such material shall be returned to the COR at NAVINFOWARCEN Atlantic.

8. Contract will ensure that all personnel have completed Anti-Terorrist/Personal Safety training will be completed before going overseas.

9. COMSEC account required. The contractor shall comply with the provisions of the NSA CSSM 3-16. The NSA COR has primary responsibility for the auditing of all COMSEC material governed by the NSA CSSM 3-16. The Cognizant Security Office is responsible for inspecting for compliance with the COMSEC Supplement to the NISPOM.

10. Access to RESTRICTED DATA (RD) requires a final U.S. Government clearance at the appropriate level.

11. Brief, user agreement and training will be required and provided by the US Government for contractors with access to Restricted Data (RD), Formerly Restricted Data (FRD).

12. NAVINFOWARCEN Atlantic POC: Raymond S. DeGuzman, Code 55280, 843-218-3892, raymond.deguzman@navy.mil.

13. Places of performance (continued):

Navy and Marine Corps shore facilities worldwide (CONUS and OCONUS) Navy and Marine Corps afloat locations worldwide (CONUS and OCONUS) Antarctica Southwest Asia (potential Hostile areas) Other sovereign and foreign Government and commercial facilities

*****NOTHING FOLLOWS*****

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

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.)

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

NAVINFOWARCEN Atlantic

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

N65236

c. ADDRESS (Include ZIP Code) NAVINFOWARCEN Atlantic P.O. Box 190022 North Charleston, SC 29419-9022

d. POC NAME

Raymond S. DeGuzman, Code 55280

e. POC TELEPHONE (Include Area Code)

+1 (843) 218-3892

f. EMAIL ADDRESS (See Instructions) raymond.deguzman@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)

Thompson, Jahmal R

b. TITLE

Contracting Officer's Security Representative

c. ADDRESS (Include ZIP Code) Naval Information Warfare Center Atlantic P.O. Box 190022 North Charleston, SC 29419-9022

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

N65236

e. CAGE CODE OF THE PRIME CONTRACTOR

(See Instructions.)

f. TELEPHONE (Include Area Code)

+1 (843) 218-2151

g. EMAIL ADDRESS (See Instructions) jahmal.r.thompson@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.)

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)

***CONTINUED IN BLOCK 13***

2. Those contractors will require a TOP SECRET security clearance per SECNAV M-5510.36, SECNAV M-5510.30 and DoD 5220.22-M. Additional security guidance will be provided by the NAVINFOWARCEN Atlantic Security Manager.

3. Only persons actually performing classified tasks on this contract shall be required to obtain and maintain security clearances per DoD 5220.22-M.

4. Documentation obtained for use with this contract shall not be used for any other purpose unless prior authorization has been obtained from NAVINFOWARCEN Atlantic.

5. Contractors will understand and practice sound OPSEC principles per OPNAVINST 3432.1 and SPAWARSYSCENINST 3432.1 and ensure that employees receive OPSEC training by the government upon initial assignment and annually thereafter.

6. Controlled Unclassified Information (CUI), such as For Official Use Only (FOUO) will be handled and safeguarded per DoDM 5200.01, Volume 4.

7. The contractor shall not downgrade, declassify, or destroy any classified documentation used with this contract. All such material shall be returned to the COR at NAVINFOWARCEN Atlantic.

8. Contract will ensure that all personnel have completed Anti-Terorrist/Personal Safety training will be completed before going overseas.

9. COMSEC account required. The contractor shall comply with the provisions of the NSA CSSM 3-16. The NSA COR has primary responsibility for the auditing of all COMSEC material governed by the NSA CSSM 3-16. The Cognizant Security Office is responsible for inspecting for compliance with the COMSEC Supplement to the NISPOM.

10. Access to RESTRICTED DATA (RD) requires a final U.S. Government clearance at the appropriate level.

11. Brief, user agreement and training will be required and provided by the US Government for contractors with access to Restricted Data (RD), Formerly Restricted Data (FRD).

12. NAVINFOWARCEN Atlantic POC: Raymond S. DeGuzman, Code 55280, 843-218-3892, raymond.deguzman@navy.mil.

13. Places of performance (continued):

Navy and Marine Corps shore facilities worldwide (CONUS and OCONUS) Navy and Marine Corps afloat locations worldwide (CONUS and OCONUS) Antarctica Southwest Asia (potential Hostile areas) Other sovereign and foreign Government and commercial facilities

*****NOTHING FOLLOWS*****

P.O. Box 190022 North Charleston, SC 29419-9022 Address: Naval Information Warfare Center Atlantic P.O. Box 190022 North Charleston, SC 29419-9022