06_DD254_signed.pdf
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- Attached to
- PCCIE MAC III SOLICITATION Federal contract opportunity
- Solicitation number
- FA8217-20-R-5002
About this file
This document package includes a DD Form 254 and related federal contract solicitation. The DD Form 254 outlines security classification specifications for a contract requiring access to secret information and SIPRNet. It specifies that the contractor will need secret clearances for most tasks and top secret clearances for some. The related federal contract solicitation is for the Power Conditioning Continuation Interfacing Equipment Program to provide commercially available uninterruptible power supply systems and equipment worldwide. The solicitation number is FA8217-20-R-5002 and proposals are due by June 2, 2020 to the Department of the Air Force Materiel Command Lifecycle Management Center located at Hill Air Force Base. All questions regarding the solicitation must be submitted by May 1, 2020 to the listed point of contact.
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DD Form 254 Addendum
OPSEC
Ref Item 11.j. OPSEC requirements are as follows: Reference: National Security Decision Directive (NSDD) 298 DOD 5205.02
DODD 5205.02E
AFI10-701AFGM_2018-01
All contractors, subcontractors, their employees, associates, and consultants who have access to critical information must comply with the DOD and Air Force-sponsored Operations Security (OPSEC) program. The OPSEC Program is directed by NSDD298, DOD Publications, and applicable Air Force guidance.
OPSEC is a systematic means of identifying and protecting information, which an adversary could use to their advantage or to our disadvantage. Critical Information (CI) is generally unclassified but can become classified through compilation. This sensitive information has been identified by the organization’s OPSEC program as requiring protection. OPSEC Measures (OM) are control standards with which all personnel must comply in order to protect CI against adversaries.
RESPONSIBILITIES:
The AFLCMC/HBZ OPSEC Program Coordinator Mr. Theodore Yost, NH-03 will provide / approve OPSEC training curriculum for use by the contractor. Critical Information and Indicator Listings (CIILs) will be protected by all contract personnel. Approved organizational OPSEC measures will be used by all contract personnel to protect critical information in their possession and protect against current foreign intelligence and industrial espionage threats. The OPSEC PM/Coordinator and the Lead contractor must ensure all contract personnel working on the contract or having access to CI attend initial and annually recurring refresher training and that the approved curriculum is presented. Training will be provided before contract personnel are allowed access to or handling of critical information. All contract personnel will comply with the organizations OPSEC standards and practices as trained. Additional training may be required based on updates to critical information, OPSEC measures, intelligence threat/vulnerability, or other fundamental changes to the OPSEC program. The OPSEC Coordinator is responsible for contacting the OPSEC Program Manager if OPSEC isn’t written into the contract.
The OPSEC PM/Coordinator for the organization will track OPSEC training statistics for all personnel working on the contract, when each individual has received the required OPSEC training, and when refresher training is due. Forward training statistics to the installation OPSEC PM at the end of each calendar quarter and/or upon request. The OPSEC Coordinator will provide a copy of the Complex OPSEC Plan to the contractor upon request and the contractor is subject to the requirements of that plan. The Complex OPSEC Plan is “for official use only” and distribution outside the constraints of the contract in part or in its entirety is prohibited. Upon completion of the contract, the contractor will destroy the OPSEC Plan by shredding the document so that it cannot be reconstructed and deleting any electronic copies.
Contactors with OPSEC requirements within a contract must ensure employees receive OPSEC training as specified within the contract. Accomplishment of training must not exceed 90 days from initial assignment to a contract with OPSEC requirements. Annual training will be accomplished NLT 30 September of each year. The contractor personnel will not be given access to an organization’s CIIL until after training has been completed and documented by the organization OPSEC Coordinator.
Prior to seeking approval through Hill AFB Public Affairs, any information to be released outside of official U.S. Government channels, via any media, must be approved through an OPSEC review by the AFLCMC/HBZ Coordinator. All personnel must promptly report OPSEC related incidents, issues, and concerns to the AFLCMC/HBZ Coordinator, 801-586-8008, who will then report it to the installation PM, 801-586-8008.
Solicitation #: FA8217-20-R-0002
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) Ref 11.j OPSEC Addendum.docx
| CurrentPage: |
| PageCount: |
| Classification: Unclassified |
| SerialNum: |
| a. Facility clearance level. Select one.: 1 |
| b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 4 |
| Choose Yes or No: 0 |
| Choose Yes or No: 1 |
| Prime: |
| Choose Yes or No: 0 |
| Choose Yes or No: 0 |
| Sub: |
| Choose Yes or No: 1 |
| Choose Yes or No: 0 |
| Soli: FA8217-20-R-0002 |
| DueDate: 2020-06-17 |
| dateA: 2020-04-13 |
| RevisionNum: |
| dateB: |
| Final: |
| dateC: |
| No: 1 |
| No: 1 |
| No: 0 |
| No: 0 |
| Yes: 0 |
| Yes: 0 |
| Yes: 1 |
| Yes: 1 |
| Enter your name here.: |
| ReqDated: |
| Enter your name here.: |
| Name: TBD |
| Name: N/A |
| Name: Wade Pilcher |
| Cage: TBD |
| Cage: N/A |
| Cage: TBD |
| CSO: TBD |
| CSO: N/A |
| addrow: |
| Removerow: |
| Click to delete a row: |
| Location: World Wide - Intermittent Visitor Group |
Actual performance TBD on each delivery order issued under basic contract.
| Block9: The Power Conditioning Continuation Interfacing Equipment (PCCIE) Program Office utilizing the current contract is responsible for providing commercial Uninterruptible Power Supply Systems to condition and backup the Air Force's, DoD, and other government agencies sensitive electronic mission equipment worldwide. |
| a: 0 |
| a: 1 |
| a: 1 |
| f: 0 |
| f: 0 |
| f: 0 |
| b: 0 |
| b: 0 |
| b: 0 |
| g: 0 |
| g: 0 |
| c: 0 |
| c: 0 |
| c: 1 |
| h: 0 |
| h: 0 |
| d: 0 |
| d: 0 |
| d: 0 |
| i: 0 |
| i: 0 |
| SCI: 0 |
| NonSCI: 0 |
| j: 1 |
| j: 1 |
| k: 1 |
| k: 0 |
| Enter your name here.: SIPRNET Access Required |
| Enter your name here.: The AFFARS CLause 5352.204-9000 applies |
| e: 1 |
| e: 1 |
| l: 0 |
| m: 1 |
| direct: 0 |
| thru: 1 |
| Enter your name here.: 75 ABW Public Affairs Office, 7981 Georgia Street, Hill AFB, UT 84056 (801-777-5201) |
| PublicAuthority: AFIMSC, Public Affairs (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330- 1690 |
| AddSig: |
| RemoveSig: |
| text: Item 13.a. DD FM 254 Review: 15 April 2025 |
Ref. 10.j.: CUI information provided under this contract shall be safeguarded as specified in DOD Manual 5200.01, Volume 4, DoD Information Security Program: Controlled Unclassified Information (CUI).
Ref 10.k.: The contractor is permitted access to the Secret Internet Protocol Router Network (SIPRNet). Actual knowledge, generation, or production of NATO information is not required for performance on this contract; however, a NATO awareness briefing will be completed prior to granting access to the SIPRNet.
Ref 10.k.: The contractor requires access to the facility within the SCIF and other areas to be determined upon Delivery Order to assess electrical infrastructure. The contractor cannot be escorted without the proper clearance. The contractor shall be required to obtain security clearance and support issues of Government identification and controlled area badges for all of their employees working in such areas prior to starting execution of task/delivery orders. Access to and familiarity with Joint Personnel Adjudication System (JPAS) and Visitor Authorization Request (VAR) may be necessary for processing clearance requests. VAR shall be submitted 30 days in advance to the site security representative. Almost all tasks will require employees to have a final U.S. Government issued Secret clearance and for some employees they must have a final U.S. Government issued Top Secret security clearance and be Director of Central Intelligent Directive (DCID) 6/4 eligible with a current Single Scope Background Investigation (SSBI). Almost all tasks will require a secret clearance and for some a top secret is anticipated. The contractor requires access to the facility within the SCIF and other areas to be determined upon Delivery Order to assess electrical infrastructure. The contractor cannot be escorted without the proper clearance. The contractor shall be required to obtain security clearance and support issues of Government identification and controlled area badges for all of their employees working in such areas prior to starting execution of task/delivery orders. Access to and familiarity with Joint Personnel Adjudication System (JPAS) and Visitor Authorization Request (VAR) may be necessary for processing clearance requests. VAR shall be submitted 30 days in advance to the site security representative. Almost all tasks will require employees to have a final U.S. Government issued Secret clearance and for some employees they must have a final U.S. Government issued Top Secret security clearance and be Director of Central Intelligent Directive (DCID) 6/4 eligible with a current Single Scope Background Investigation (SSBI). Almost all tasks will require a secret clearance and for some a top secret is anticipated.
Ref 11.a: Contract performance is restricted to locations identified in Items 8.a. - 8.c. The Government activities at these locations will provide security classification guidance for performance of this contract.
Ref. 11.e: Contract is for equipment maintenance services on equipment which processes classified information. Actual knowledge, generation, or production of classified information is not required for performance of the contract. Cleared personnel are required to perform this service because visual or aural access to classified information cannot be precluded by escorting personnel. Any classification guidance will be provided by the using activity.
Ref. 11.m.: The contractor is designated as a Intermittent Visitor Group and will provide the information requested by the Notification of Government Security Activity and Visitor Group Security Agreements Clause, Air Force Federal Acquisition Regulation Supplement 5352.204- 9000, to the Servicing Security Activity addresses, listed in Item 15 “Ref: 8.a”, at least 30 days prior to beginning operations.
| attachmentsList: |
| AddAttachment: |
| ViewAttachment: |
| RemoveAttachment: |
| rep: Jeremy J. Deaton, AFLCMC/HBZBD, PCCIE Program Manager |
| rep: Theodore R. Yost, AFLCMC/HBZ, Security Manager |
| rep: LaShonda R. Arocha, 75 ABW/IPD, Industrial Security Specialist |
| Sig: |
| Enter your name here.: Ref 11.j: The contractor must comply with the U.S. Government, DOD, Air Force, AFMC, AFLCMC/HBZ, Operations Security (OPSEC) Programs. The contractor must comply with any additional OPSEC requirements referenced in the applicable OPSEC addendum attachment within Item 13. |
| Enter your name here.: Ref. 8.a.: The Defense Counterintelligence and Security Agency (DCSA) is relieved of all industrial security review responsibilities for contractor performance on government installations identified in Items 8.a. The following SSAs have exclusive oversight responsibilities while operating on the installations: TBD |
| GCAName: Wade Pilcher |
| AAC: FA8217 |
| AAC: FA8217 |
| Address: 6039 Wardleigh Rd (BLdg 1206) |
Hill AFB, UT 84056 Address: 6039 Wardleigh Rd (BLdg 1206) Hill AFB, UT 84056
| POCName: Wade Pilcher |
| Phone: 8015861229 |
| Phone: 8015861229 |
| Email: wade.pilcher@us.af.mil |
| Email: wade.pilcher@us.af.mil |
| Title: PCO |
| Enter the date using the format DD-Mon-YYYY: 20200413 |
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