Attach 0003 - DD Form 254.pdf

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DD Form 254 – Item 13 Continuation Solicitation Number:

Contract Number:

ALL ITEMS CHECKED YES, APPLY TO THIS EFFORT. ITEMS CHECKED NO ARE NOT APPLICABLE TO THIS EFFORT

AND REQUIREMENTS WILL NOT BE LEVIED AGAINST THE CONTRACTOR.

4. Follow-on contract - The classified portion of work has been completed on the contract cited in this item. The processing of classified will no longer be done under this contract. All classified material/information associated with this contract is authorized to be transferred to the contract number cited in Item 2a.

Remarks:

8. Actual Places of Performance: REFERENCE ITEM 8 OF DD FORM 254 FOR ACTUAL PLACES OF PERFORMANCE. SPECIFIC REMARKS REGARDING THOSE LOCATIONS ARE FOUND BELOW AND/OR PLACES OF

PERFORMANCE ARE DUPLICATED BELOW.

10a. COMSEC - Access to COMSEC material is required in the performance of this contract. Access to COMSEC requires a final clearance. The contractor may be authorized to receive government furnished cryptographic equipment, if a COMSEC account is required and if Item 11h of this DD Form 254 is checked. Contractor personnel are subject to The Department of Army Cryptographic Access Program (DACAP), IAW AR 380-40. The contractor shall comply with NSA/CSA Manual 3-16, AR 380-40, and the Committee of National Security Systems Instructions (CNSSI) 4001, “Control of Communications Security Material,” or other guidance provided by the central office of record. If access to COMSEC information is required at Government facilities, contractor shall adhere to the government/program COMSEC plan or guidance. Approval by the KO/COR is required prior to transporting or carrying classified COMSEC material on a cleared commercial carrier or passenger aircraft.

The government program/project manager shall designate the number of personnel requiring cryptographic (CRYPTO) access. Approval by the KO is required prior to the flow down of COMSEC requirements to any subcontractor.

YES NO

20201001

10b. Restricted Data - Contractor requires access to Restricted Data per the PWS. Refer to 10 CFR 1045 “Nuclear Classification and Declassification” and Atomic Energy Act of 1954, as amended, for further information.

Approval by the KO is required prior to the flow down of Restricted Data requirements to any subcontractor.

10c. Critical Nuclear Weapon Design Information - Contractor requires access to Critical Nuclear Weapon Design Information (CNWDI). Special briefings and procedures are required. Approval by the KO is required prior to the flow down of CNWDI requirements to any subcontractor.

10d. Formerly Restricted Data - Contractor requires access to Formerly Restricted Data (FRD) per the PWS, SOW, or SOO.

10e(1). Sensitive Compartmented Information (SCI) - Access to Intelligence information that is Sensitive Compartmented Information (SCI) may be required in the performance of this contract. Refer to the SCI Addendum for additional guidance. Contractors are required to complete SCI training requirements through COR approved appropriate training systems/databases (e.g., Total Employee Development (TED), Security Training, Education and Professionalization (STEPP)). Only those personnel that require access to SCI information to complete their job duties will be provided SCI access. Approval by the KO is required prior to the flow down of SCI requirements to any subcontractor.

10e(2). Non-Sensitive Compartmented Information (Non-SCI) - Access to Intelligence information that is Non- Sensitive Compartmented Information (Non-SCI) may be required in the performance of this contract. Approval by the KO is required prior to the flow down of Non-SCI requirements to any subcontractor.

10f. Special Access Programs - Contractor requires access to Special Access Program (SAP) Information per the PWS, SOW, or SOO. Contractor will comply with DoDM 5205.07 (Volumes 1-4), AR 380-381, and requirements and directions provided by the Program Security Officer (PSO), name and contact information found below, or successor. Approval by the KO is required prior to the flow down of SAP requirements to any subcontractor.

Requiring Activity’s (RA) PSO is required to provide the SAP Security Plan to contractors for adherence.

PSO Name (must be completed if 10f is checked YES):

PSO Contact Information (Phone and DISA Email):

10g. North Atlantic Treaty Organization - Contractor requires access to North Atlantic Treaty Organization (NATO) Information per the PWS requires a final clearance. Approval by the KO is required prior to the flow down of NATO requirements to any subcontractor. Refer to item 13e for NATO training guidance in Item

10h. Foreign Government Information - Contractor requires access to Foreign Government Information (FGI) per the PWS, SOW, or SOO. Access to FGI requires final clearance.

10i. Alternative Compensatory Control Measures - Contractor requires access to Alternative Compensatory Control Measures (ACCM) Information.

10j. Controlled Unclassified Information (CUI) - Access to Controlled Unclassified Information (CUI) is required in the performance of this contract. Information designated as CUI, generated or provided under this contract shall be controlled, handled, stored, marked, safeguarded, transmitted, and destroyed IAW DoDI 5200.48, AR 380-5.

Electronically transmitted CUI shall be sent via:

o Emailing CUI between the Government and a Contractor: Digitally encrypted email can be accessed via DOD CAC or if the Contractor's company has the proper DOD-approved assurance certificates installed. For more details on DOD-approved assurance certificates visit https://public.cyber.mil/eca/.

o Government SharePoint: Contractor must have a DOD CAC and access is based on the Government's approval.

o DOD Safe (use email certification to enter site) https://safe.app.mil/ o IntelDocs - https://inteldocs.intelink.gov/inteldocs o CD/DVD: Save CUI-marked files to a CD/DVD and properly mail to recipient.

o Fax: Send CUI-marked documents via facsimile machine to recipient.

o An accredited information system with proper security controls.

The contractor may disseminate CUI information to their employees and subcontractors that have a need-to-know.

The contractor shall report the unauthorized disclosure of CUI to the COR.

10k. SCGS – SCGs associated with this effort are listed below by title, date, and office of primary responsibility per AR 380-49. Contractor will require access to all SCGs listed below:

Remarks: (ENTER ALL SCGs ASSOCIATED WITH THIS EFFORT BY TITLE, DATE, AND FUNCTIONAL OFFICE OF

PRIMARY RESPONSIBILITY)

1. ARCYBER SCG FOR CYBERSPACE OPERATIONS AND SECURITY, DATED 19 MAY 2016, U.S. ARMY CYBER COMMAND AND SECOND ARMY, or most current SCG.

10k. SIPRNet - Secured Internet Protocol Network (SIPRNet) access is required for the performance of the contract. Requests for access will be submitted to COR to facilitate the local vetting and approval process.

Contractor must follow appropriate processes for obtaining login credentials to SIPRNet. Contractor personnel must be cleared at the NATO SECRET level in order to obtain access to SIPRNet. If SIPRNet is required at contractor facility, contractor shall coordinate with appropriate DSS representatives. The contractor requires access to the Defense Information Systems Network (DISN) Secret Internet Protocol Routing Network (SIPRNet) dated 01 June 2013, or most current.

10k. JWICS - JWICS access is required for the execution of the contract. Requests for access will be submitted to COR to facilitate the vetting and approval process. Contractor must follow appropriate processes for obtaining login credentials to JWICS. Contractor personnel must be cleared at the NATO SECRET level in to obtain access to JWICS. If JWICS is required at contractor facilities, the contractor shall coordinate with the appropriate Special Security Officer (SSO) and/or Contractor Special Security Officer (CSSO). The Contractor requires access to the JWICS SCG, Defense Intelligence Agency, dated 29 September 2017, or most current.

10k. NSANet - NSANet access is required for the execution of the contract. Requests for access will be submitted to COR to facilitate the vetting and approval process. For access to NSANet requires final clearance. Contractor must follow appropriate processes for obtaining login credentials to NSANet.

10k. Other classified IS – (Add tailored verbiage provision for using other classified IS)

11a. Have access to classified information only at another contractor’s facility or at a government activity - The contractor shall have access to classified information only at another contractor’s facility or at a government activity. If this item is checked, than safeguarding of classified is NONE and items 11b, 11c, 11d, 11h, or 11k do not apply to this effort.

11b. Receive and store classified documents only - Contractor is authorized to receive classified documents only for purposes named in the remarks below. There will be no generation or derivative classification of material at the contractor facility. Special storage requirements are listed in remarks below.

11c. Receive, store, and generate classified information or material - Contractor is authorized to receive, store, and generate classified material at the contractor’s facility. Contractor will reference the appropriate security classification guidance when generating or deriving classified material or hardware, reference item 10k. All classified information received or generated will be properly stored and handled according to the markings on the material. All classified information received or generated is the property of the U.S. Government. At the termination or expiration of this contract, the U.S. Government will be contacted for proper disposition instructions.

11d. Fabricate, modify, or store classified hardware - Contractor will fabricate, modify, or store classified hardware at their facility. A description of the area required to store such material and details regarding what the contractor will require, can be found in the remarks below.

11e. Perform services only - Contractor will perform services only as described in the remarks below:

11f. Have access to U.S. classified information outside the U.S., Puerto Rico, U.S. Possessions, and Trust Territories - The contractor will have access to classified information at OCONUS locations. Refer to item 8a for a listing of OCONUS locations. RA is responsible for identifying security oversight for the OCONUS locations and ensuring compliance with Foreign Clearance Guide (https://www.fcg.pentagon.mil/fcg.cfm).

11g. Be authorized to use the services of Defense Technical Information Center (DTIC) or other secondary distribution center - The contractor will prepare DD Form 1540, Registration for Scientific and Technical Information Services and DD Form 2345, Militarily Critical Technical Data Agreement, for authorized access to Defense Technical Information Center DTIC. Completed forms will be provided to the KO/COR for processing and submission to DTIC.

11h. Require a COMSEC account - Contractor requires a COMSEC account. Access to COMSEC requires a final clearance. If this item is checked, then item 10a will be checked.

11i. Have a TEMPEST requirement - The contractor shall submit a TEMPEST countermeasure review (TCR) worksheet to the Army certified TEMPEST technical authority (CTTA) and coordinate with their Cognizant Security Agency (CSA) for CTTA TEMPEST countermeasure implementation IAW AR 380-27, paragraph 2-6g.

11j. Have Operations Security (OPSEC) Requirements – (ALWAYS REQUIRED) (REQUIRED WHEN THE PLACE OF PERFORMANCE IS AT GOVERNMENT INSTALLATIONS/FACILITIES) While performing work at Government facilities, the contractors shall adhere to the OPSEC requirements IAW the OPSEC Plan/SOP listed by name and date, in the REMARKS BELOW, or its most current version. The OPSEC plan will be provided to the contractor after contract has been awarded.

and/or (REQUIRED WHEN THE PLACE OF PERFORMANCE IS AT THE CONTRACTOR’S FACILITY) If performing on contractor site, the contractor shall have an identified certified Level II OPSEC coordinator per AR 530-1. The contractor shall develop an OPSEC Plan IAW AR 530-1 as listed in the PWS, SOW, and, SOO CDRL NUMBER BELOW. RA is responsible for providing to the contractor a current and valid program/command OPSEC Plan.

The contractor will use the program/command OPSEC Plan to ensure the contractor developed OPSEC Plan includes the same Critical Information List (CIL) and OPSEC measures.

Remarks: (ENTER OPSEC PLAN[S] ASSOCIATED WITH THIS EFFORT BY TITLE AND DATE)

11k. Be authorized to use Defense Courier Service (DCS) - Contractor is authorized to use Defense Courier Service (DCS). The KO/COR will obtain written approval from the United States Transportation Command’s (USTRANSCOM) Defense Courier Division (TCJ3-C), Scott AFB, IL 62225-5357. Only certain classified information qualifies for shipment by DCS. If applicable, COMSEC material will be transported via DCS as described in remarks below.

11l. Receive, store, or generate CUI - Contractor is authorized to receive, store, or generate CUI in the performance of this contract. Information designated as CUI, generated under this contract shall be controlled, handled, stored, marked, safeguarded, transmitted and destroyed IAW DoDM 5200.48, AR 380-5, and the following guidance:

Electronically transmitted CUI shall be sent via:

o Emailing CUI between the Government and a Contractor: Digitally encrypted email can be accessed via DOD CAC or if the Contractor's company has the proper DOD-approved assurance certificates installed. For more details on DOD-approved assurance certificates visit https://public.cyber.mil/eca/.

o Government SharePoint: Contractor must have a DOD CAC and access is based on the Government's approval.

o DOD Safe (use email certification to enter site) - https://safe.app.mil/.

o IntelDocs - https://inteldocs.intelink.gov/inteldocs o CD/DVD: Save CUI-marked files to a CD/DVD and properly mail to recipient.

o Fax: Send CUI-marked documents via facsimile machine to recipient.

The contractor may disseminate CUI information to their employees and subcontractors that have a need-to-know.

The contractor shall report the unauthorized disclosure of CUI to the COR.

11m. Other/IT sensitive duties required - Refer to Item 13 for IT requirements.

12. Public Release - All requests for public release shall be submitted by the government COR utilizing the CECOM Public Release Approval System (PRAS) at: https://pras.army.mil/PRAS/default.asp and/or through OPSEC Officer and Public Affairs Office (PAO) identified below:

OPSEC Officer and Contact Information (include phone, email, and mailing address):

PAO (include phone, email, and mailing address):

13a. Base Contract Only – Specific security requirements, e.g., SCG, place of performance, access, etc., are contingent upon each task order and shall be stipulated in the task order’s DD254.

13b. IT Levels - IT Level Designations. Contractor personnel shall be designated as IT-I IT-II or IT-III, as defined in the Traditional Security Checklist: Version 1, Release 3, Benchmark Date 15 Jun 2020, STIG ID: PE-02.02.01 at https://cyber.mil/. Contractor personnel shall obtain the appropriate security screening as prescribed in STIG PE-02.02.01 and DoD 8570.01-M (Ch4), before being granted access to DoD information technology (IT) systems that contain classified/sensitive data. Upon request by the Contractor, the Government will initiate the investigation for IT level access to DoD IT systems that contain classified/sensitive data and grant an interim IT-I or IT-II access determination investigation. Cleared contractors shall ensure all personnel are designated as IT-I, IT-II, or IT-III in the DISS/JPAS Personnel Summary. Contractor Visitor Access Requests (VARs) shall also be annotated with the appropriate IT level and appropriately cleared IAW DoDI 8500.01 and Homeland Security Presidential Directive 12 for the following investigation requirements: IT/ADP Level I- Tier 5; IT/ADP Level II- Tier 3; and IT/ADP Level III (Normal IT user)- Tier I."

13c. Spillages - Classified and covered defense information, as defined in DFARS 252.204-7012, information, will be protected IAW the NISPOM and DFARS 252.204-7012. All security and cyber incidents involving classified and covered defense information, e.g., spillage, shall be immediately reported to the RA Security Specialist and to their DSS Industrial Security Representative. A spillage occurs whenever or covered defense information is transferred onto an information system not authorized for the appropriate security level or exploited by external/malicious sources. Information will be forwarded to KO/COR and the Program Manager for a program damage assessment to be conducted IAW AR 380-49. Contractors responsible for a willful or negligent spillage of information shall pay enterprise service providers for the associated cleanup costs across the enterprise to restore the affected network or networks to a normal operating configuration.

13d. PWS, SOW, or SOO - The PWS, SOW, or SOO shall be provided to the contractor’s FSO and/or CSSO along with the DD Form 254 and associated Continuation Pages. This is to ensure that the FSO and/or CSSO are aware of all contractual requirements relating to security within the effort.

13e. NATO Awareness Briefing - All cleared contractor personnel shall obtain a NATO Security Awareness Briefing from their FSO and/or from their program security specialist. NATO Awareness Briefing can be found at the following CAC enabled link http://www.cdse.edu/documents/toolkits-fsos/NATO Brief.pdf

13f. OCONUS Travel - Contractors traveling to OCONUS locations for either official or unofficial travel may require a defensive counterintelligence briefing prior to their departure. Requirement for defensive travel brief will be based on threat and will remain at the discretion of the G2 and/or organization’s security manager.

20201001 Page 11 of 13

13h. Security Trainings/Briefings - Several training requirements exist for contractor personnel per DoD and Army regulation/directives. On-site contractors may receive training briefs from the government appointed Security Manager; however, contracting companies will be required to provide training to off-site contractor employees. Training is tailored to the organization’s requirements as well as local policy. Some examples of Security training provided to integrated/embedded contractors may include, but is not limited to, the following:

Threat Awareness Reporting Program (required for all contractors with security clearances) - Per AR 381-12 Threat Awareness and Reporting Program (TARP), cleared contractor employees must receive annual TARP training by a CI agent or other trainer as specified in 2-4b.

Initial Security Orientation: Online training available on the Army Learning Management System (ALMS) site, reference ALARACT 207-2103 - Initial training

Annual Security Orientation: Online training available on the Army Learning Management System (ALMS) site, reference ALARACT 207-2103 - Annual training requirement

Derivative Classification Training, reference DoD 5200.01-V3- Annual training requirement Foreign travel training, AR 525-13 - Required when traveling abroad Department of the Army (DA), Army Material Command (AMC), and/or commander directed security stand-downs, e.g., ad-hoc refresher trainings.

13i. Security Classification Guides - Per AR 380-49, the RA is required to identify by title, functional office of primary responsibility, and approval date, the SCGs applicable to the contract on the DD Form 254 within item

13. The requirement for SCG(s) must also be annotated on DD Form 254, block 10k. Due to the mission and its reimbursable nature, it is impossible to proactively identify all SCGs associated with contract efforts. However, upon identification, the RA shall immediately provide SCGs related to the classified information associated with the execution of this contract.

13j. Individual Courier Card - Must have a need to know and approval from the COR prior to Courier Cards being issued.

13k. Additional Remarks not already addressed in items 1a – 13i of this Security Appendix.

13g. Generation of classified material - The generation of classified material includes derivatively classified information. YES NO

Certification and Signature (ALWAYS REQUIRED - IF SCI CONTRACT, THE SCI CONTRACT MONITOR MUST ALSO SIGN) 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(s) named below. Signature block for COR and/or PM required.

COR SIGNATURE (ALWAYS REQUIRED)

X___________________________________________

NAME:___________________________________________

DATE:___________________________________________

TITLE:___________________________________________

EMAIL:___________________________________________

COMM:___________________________________________

CM SIGNATURE (REQUIRED ON SCI CONTRACTS)

X___________________________________________

NAME:___________________________________________

DATE:___________________________________________

TITLE:___________________________________________

EMAIL:___________________________________________

COMM:___________________________________________

20191001

Remarks: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks_2: Northrop Grumman Corp 600 S. Hicks Rd.

Rolling Meadows IL. 60008

Remarks_3: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Group3: Choice1

4: Choice4

5: Choice5

Remarks_5: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks_6: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks_7: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

7: Choice9

8: Choice11

9: Choice13

10: Choice15

Text5: PANAPG-20-P-0000 008093

Text6:

Remarks_8: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

PSO Name must be completed if 10f is checked YES: NOT APPLICABLE.

PSO Contact Information Phone and DISA Email: NOT APPLICABLE.

Remarks_9: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

11: Choice17

12: Choice19

Remarks_10: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

13: Choice21

14: Choice23

Remarks_11: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks_12: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

15: Choice26

16: Choice28

Remarks_13:

Remarks ENTER ALL SCGs ASSOCIATED WITH THIS EFFORT BY TITLE DATE AND FUNCTIONAL OFFICE OF PRIMARY RESPONSIBILITY 1 ARCYBER SCG FOR CYBERSPACE OPERATIONS AND SECURITY DATED 19 MAY 2016 US ARMY CYBER COMMAND AND SECOND ARMY or most current SCG: Security Classification Guide (SCG) for U.S. Army Version of Aircraft Survivability Equipment (ASE), 4 February 2014, Project Manager ASE, SFAE-IEW-ASE

Remarks_14: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

to the JWICS SCG Defense Intelligence Agency dated 29 September 2017 or most current: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks_15: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

17: Choice29

18: Choice31

19: Choice33

Remarks_16: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks_17: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

20: Choice35

21: Choice37

22: Choice39

Remarks_21: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

23: Choice42

24: Choice44

25: Choice45

Remarks_19:

Remarks_20:

Remarks_22: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks_23: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks_24: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

26: Choice47

27: Choice49

28: Choice51

Remarks_26: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

29: Choice53

30: Choice56

31: Choice57

Remarks_25: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks ENTER OPSEC PLANS ASSOCIATED WITH THIS EFFORT BY TITLE AND DATE: United States Army Communications-Electronics Command, Integrated Logistics Support Center, Operations Security (OPSEC) Plan AR 530-1, (Updated) 13 June 2017. CDRL Number #TBD

Remarks_27:

Remarks_28: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

32: Choice60

33: Choice61

OPSEC Officer and Contact Information include phone email and mailing address: CECOM ILSC OPSEC OFFICER, Andrea K. Ferrell, andrea.k.ferrell.civ@mail.mil 443-861-5609

PAO include phone email and mailing address: Pamela Leigh, PAO pamela.a.leigh.civ@mail.mil / 443.861.7117 6588 Surveillance Loop, APG, MD 21005

35: Choice66

37: Choice3

38: Choice5

39: Choice7

40: Choice7

41: Choice7

Remarks_29:

42: Choice7

43: Choice7

44: Choice7

45: Choice8

NAME: Ritsa Karakanas

NAME_2:

DATE: 10/15/2020

DATE_2:

TITLE: COR

TITLE_2:

EMAIL: ritsa.d.karakanas.civ@mail.mil

EMAIL_2:

COMM: 443-861-7996

COMM_2:

2020-10-15T11:23:14-0400

KARAKANAS.RITSA.D.1390380549

35a: Choice66

10a: Choice15

Remarks_18: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

Remarks_31: NOT APPLICABLE TO THIS EFFORT. REQUIREMENT WILL NOT BE LEVIED ON THE CONTRACTOR.

36: Choice7

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 [1] (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form) DD Form 254 Item 13 Continuation NGC APR39.pdf

COLUMBUS, OH (443) 861-4555