RFQ_Att. 4_DD254_Draft.pdf

(Updated 20250815) CLASSIFICATION (When filled in): CUT N6817126Q1015

DEPARTMENT OF DEFENSE 0MB No. 0704-0567 CONTRACT SECURITY CLASSIFICATION SPECIFICATION 0MB approval expires:

(The requirements of the National Industrial Security Program (NISP) apply to all security aspects of this effort involving classified information.) August 31, 2028

The public reporting burden for this collection of information, 0704-0567, is estimated to average 36 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 eatimate 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 0MB control number.

RETURN COMPLETED FORM AS DIRECTED IN THE INSTRUCTIONS.

1. CLEARANCE AND SAFEGUARDING

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION!

(See Instructions) MATERIAL REQUIRED AT CONTRACTOR FACILITY

Secret Secret

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

a. PRIME CONTRACT NUMBER (See instructions.) DATE (YYYYMMDD)

a. ORIGINAL (Complete date in all cases.)

b. SUBCONTRACT NUMBER b. REVISED (Supersedes all previous specifications.)

REVISION NO. DATE (YYYYMMDD)

c. SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMDD)

c. FINAL (Complete Item 5 in all cases.) DATE (YYYYMMDD)

N68 17 126QT0 15

4. IS THIS A FOLLOW-ON CONTRACT? No Yes Ifyes, 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 b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional) EOD Mobile Unit EIGHT Intelligence Department PSC 819 Box 10

FPO, AE 09645

7. SUBCONTRACTOR(S) (Click button if you choose to add or list the subcontractors

- but will still require a separate DO Form 254 issued by a prime contractor to each subcontractor)

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 (Cilck button to add more locations.)

a. LOCATION(S) (For actual performance, see instructions.) b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) EOD Mobile Unit EIGHT BLDG 5 (If appilcable, (Name, Address, ZIP Code, Telephone required; Email Address optional)

NAVAL STATION ROTA, SPAN see Insfructions.) EOD Mobile Unit EIGHT PSC 819 Box 10 Intelligence Department

FPO, AE 09645 PSC 819 Box 10

FPO, AE 09645

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

This requirement is to provide embedded logistical and technical Subject Matter Expert (SME) support services for EODMIU EIGHT and EODMJJ EIGHT DETACHMENT EUROPE (located at NAVSTA Rota). The Government requires contractor support, performed in accordance with U.S. Navy policies, for the purpose of assisting with the accounting, documentation, data ently, movement, receipt, and issue of equipment and material, as well as coordinating material efforts and providing related technical services.

DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE.

CLASSIFICATION (When filled in): CUI

(Updated 20250815) CLASSIFICATION (When filled/n): CUI N6817126QT015

10. CONTRACTOR WILL REQUIRE ACCESS TO: X a//that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)

Z a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION b RESTRICTED DATA

g. NORTH ATLANTIC TREATY ORGANIZATION

'U (NATO) INFORMATION

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) h FOREIGN GOVERNMENT INFORMATION L_J I,i(If CNWDI applies, RESTRICTED DATA must a/so be marked.)

d FORMERLY RESTRICTED DATA

i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

e. NATIONAL INTELLIGENCE INFORMATION:

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI)

(See instructions.)

LI (1) Sensitive Compartmented Information (SCI) k. OTHER (Specify) (See instructions.)I (2) Non-SCI

11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL: (X a//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 g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE ANOTHER CONTRACTORS FACILITY OR A GOVERNMENT TECHNICAL INFORMATION CENTER (DTIC) OR OTHER

ACTIVITY SECONDARY DISTRIBUTION CENTER

(Applicable only if there is no access or storage required at contractor facility.

See instructions.) h. REQUIRE A COMSEC ACCOUNT

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY i. HAVE A TEMPEST REQUIREMENT

c. RECEIVE, STORE, AND GENERATE CLASSIFIED Z i. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

INFORMATION OR MATERIAL k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE I. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED

LI INFORMATION (CUI).

lc?1 (DOD Components: refer to DoDI 5200.48, only for specific CUl protection

e. PERF RM ERVI ES ONLY requirements. Non-DoD Components: see instructions.)

f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE

m. OTHER (Specify) (See instructions.)

THE U.S.,PUERTO RICO, U.S. POSSESSIONS AND TRUST

TERRITORIES

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) Public Release Authority:

Government Contracting Agency/US Navy

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.)

All Contractor personnel fulfilling the requirements of the contract will have a current T3 or higher background investigation with favorable SECRET adjudication: clearance and eligibility must be maintained during the performance of this contract.

Individual will require access to US and NATO networks that utilize material classified up to SECRET and NATO SECRET. Individual will also use hardware facilitated by EOD Mobile Unit EIGHT to work with material classified up to SECRET and NATO SECRET.

ELMS Warehouse is not a secret web application but the access form requires a secret clearance adjudication.

The majority of the place of performance is SECRET spaces which requires contractor access in order to complete the requirements within the PWS. Additionally, some of the material the contractor is responsible for per this PWS is secret due to composite knowledge of capabilities and limitations. While the contractor will not be operating this material, they will have access and knowledge and therefore require a SECRET clearance.

For further guidance use the latest edition on the below manuals:

DODM 5200.0 l(DOD Information Security Program), DOD 5220.22-M (National Industrial Security Program Operation Manual)

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

DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE.

CLASSIFICATION (When filled in): CUT

I'age or i

(Updated 20250815) CLASSIFICATION (When filled in): CUT N6817126QT015

NAME & TITLE OF REVIEWING OFFICIAL SIGNATURE

WILLIAMS.SHANE Digitally sigaedby

ISC Shanelle Williams, EODMU8 SSO LLE.DAVINA. 1413 taLL0,j1

402090 Date: 2026.05.26 16:31:06 #6200'

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, are established for this contract.

r N Ye If Yes, identify the pertinent contractual clauses in the contract document itself, or provide an appropriate statement which identifies the additional 0 SV^ai 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.

r' No Yes If Yes, explain and identity specific areas and government activity responsible for inspections. The field will expand as text is added or you can also use item VN 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 c. ADDRESS (Include ZIP Code)

d. POC NAME

Julius Arrascue-Pastor NAVSUP PLC SIGONELLA ROTA OFFIC Base Naval de Rota

e. POC TELEPHONE (Include Area Code)

+1(349) 568-2233 Apartado 33, 11530 Rota (Cadiz)b. ACTIVITY ADDRESS CODE (AAC) OF THE

CONTRACTING OFFICE (See Instructions) f. EMAIL ADDRESS (See Instructions)

N68 171 julius.j.arrascue-pastor.civus.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) d. AAC OF THE CONTRACTING OFFICE h. SIGNATURE (See Instructions) (See Instructions) WILLIAM Digitally signed

Williams, Shanelle D N68 171 S.SHANE WILLIAMS SH

b. TITLE e. CAGE CODE OF THE PRIME CONTRACTOR LLE.DAVI ANELLE.DAVI

(See Instructions.) NA 141340N 1413402090

EOD Mobile Unit EIGHT Intelligence Chief 2090 1631 4+0O

c. ADDRESS (Include ZIP Code) f. TELEPHONE (Include Area Code) I. DATE SIGNED EOD Mobile Unit EIGHT +1(314) 727-1853 (See Instructions)

PSC 819 BOX 10

g. EMAIL ADDRESS (See Instructions)FPO AE 09645 shanelle.d.williams.mil@us.navy.mil

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

a. CONTRACTOR f. OTHER AS NECESSARY (If more room is needed, continue in Item 13 oron additional page if necessaiy.)

b. SUBCONTRACTOR

LI c. COGNIZANT SECURITY OFFICE FOR PRIME AND

SUBCONTRACTOR

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

ADMINISTRATION

e. ADMINISTRATIVE CONTRACTING OFFICER

DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE.

CLASSIFICATION (When filled in): CUT