19AQMM-19-R-0291 DD254.pdf

CLASSIFICATION (When filled in):

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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)

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

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

a. PRIME CONTRACT NUMBER (See instructions.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

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 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)

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.)

a. LOCATION(S) (For actual performance, see instructions.) b. CAGE CODE (If applicable, see Instructions.)

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

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Unclassified

Unclassified

Industrial Security Management System

Top Secret Secret

c. SOLICITATION NUMBER

19AQMM-19-R-0291

✔ 20201103

X

X

Indefinite Delivery/Indefinite Quantity to provide Structured Telecommunications Cabling System testing services at the U.S. diplomatic facilities overseas

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DD FORM 254, APR 2018

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

b. RESTRICTED DATA

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.)

d. FORMERLY RESTRICTED DATA

e. NATIONAL INTELLIGENCE INFORMATION:

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

g. NORTH ATLANTIC TREATY ORGANIZATION

(NATO) INFORMATION

h. FOREIGN GOVERNMENT INFORMATION

i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI) (See instuctions.)

k. OTHER (Specify) (See instructions.)

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) Public Release Authority:

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.)

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

Unclassified

Unclassified

Industrial Security Management System k.1. SENSITIVE BUT UNCLASSIFIED INFORMATION (SBU) m.1. REQUIRE CONNECTIVITY TO DEPT. STATE COMPUTER SYSTEM

Overseas access to classified information at Department of State locations only

Department of State, DS/IS/IND, SA-20, 13th Floor, Washington, DC 20520

[ DD Form 254 Section 13 Security Guidance is provided separately starting on page 4. ]

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DD FORM 254, APR 2018

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

b. ACTIVITY ADDRESS CODE (AAC) OF THE

CONTRACTING OFFICE (See Instructions)

c. ADDRESS (Include ZIP Code) d. POC NAME

e. POC TELEPHONE (Include Area Code)

f. EMAIL ADDRESS (See Instructions)

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)

b. TITLE

c. ADDRESS (Include ZIP Code)

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.)

f. TELEPHONE (Include Area Code)

g. EMAIL ADDRESS (See Instructions)

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.)

Unclassified

Unclassified

Industrial Security Management System

Rachel Bibee, WCSS Section Chief, DS/IS/IND

See Specific HUMINT Threat Posts attachment

X

Department of State

19AQMM

2201 "C" Street, NW Washington, DC 20520

Rachel Bibee

571-345-3023

BibeeR@state.gov for Kimberly A. Baugher

Division Chief

DS/IS/IND, SA-20, 13th Fl.

2201 C St. NW Washington, DC 20520

19AQMM

571-345-3032

BaugherK2@state.gov

13. SECURITY GUIDANCE.

DD FORM 254, SECURITY GUIDANCE Page 4 of 5 Industrial Security Management System

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.

Contractor personnel assigned to this contract shall possess Secret or Top Secret personnel security clearances issued by Defense Counterintelligence and Security Agency (DCSA) prior to contract performance, except those individuals specifically designated by the Contracting Officer's Representative (COR) to perform only on unclassified portions of the contract and/or in areas not requiring cleared access.

Final SECRET clearances and favorable Diplomatic Security (DS) name checks are required for travel to specific HUMINT threat posts for deployments of less than 60 days (cumulative for all posts visited in a year). Interim SECRET clearances are not acceptable for such travel. Deployments in excess of 60 days require Final TOP SECRET clearances, favorable DS name checks, and submission of an acceptability review prior to deployment.

Visit Authorization Requests (VARs) for all cleared personnel performing on the contract at DOS locations are to be sent to DS/IS/IND to DSINDOBOVARS@state.gov or faxed to 571-345-3000. A VAR is valid for 12 months; an updated VAR is required 30 days prior to the current VAR expiring.

Requests for subcontract DD Forms 254 shall be emailed to DS/IS/IND at DS_IND_OBOTeam@state.gov. DD Forms 254 issued by DS/IS/IND will be provided to the prime for distribution to subcontractors, prior to subcontractor access to any classified information or CAA spaces.

All contract materials generated by the contractor shall be marked in accordance with the Security Classification Guide for Design and Construction of Overseas Facilities, dated July 2018. The contractor shall not declassify or sanitize any classified information received or generated in connection with performance of this contract without the prior approval of DS/IS/IND.

The loss, compromise, or suspected compromise of any classified or SBU information regarding this contract shall be reported immediately to the COR and DS/IS/IND. No public release of information regarding this contract shall be made without the prior approval of the Contracting Officer and DS/IS/IND.

In order to adequately perform on this contract, the successful bidder(s) will require DCSA approved safeguarding at the SECRET level. Additionally, DCSA approval to operate a classified Information System (IS) at the Secret level is required. Contractor will require a COMSEC account for access to ProjNet-C. DOS will sponsor Contractor(s) who do not already have a COMSEC account upon selection for contract award.

Transmittal of classified and SBU information between prime and subcontractors, between designated subcontractors, and to DOS, shall be strictly in accordance with the contract.

While at DOS locations, the contractor shall comply with applicable DOS regulations relative to the protection of classified and/or sensitive information, including the National Industrial Security Program Operating Manual (NISPOM), and 12 Foreign Affairs Manual (FAM) 500 and 600.

All processing, storage, and transmission of SBU data on static and portable electronic media shall be in accordance with Section H.10.15 of the contract. DS/IS/IND is responsible for inspecting contractor activities at DOS locations.

Facility Security Officers (FSOs) shall immediately report any adverse information concerning any cleared contractor employees performing on DOS contracts to DCSA, in accordance with the NISPOM and to DS/IS/IND, in accordance with 12 FAM 576.

Contractor personnel working on DOS contracts must report impending marriage or cohabitation with foreign nationals to the COR and DS/IS/IND, in accordance with 12 FAM 270.

13. SECURITY GUIDANCE.

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All FAM references can be viewed at http://foia.state.gov/.

DS/IS/IND Point of Contact: Nisha Faumuina, FaumuinaAD@state.gov, (571) 345-3014

MINIMUM PERSONNEL SECURITY REQUIREMENTS FOR SPECIFIC

HUMAN INTELLIGENCE THREAT POSTS

CONTRACT NUMBER:

Contractor personnel who will perform tasks at specific human intelligence (HUMINT) threat posts must meet specific requirements based on 12 FAM 570. The Contracting Officer’s Representative (COR) will notify the contractor when a task order is being issued for a specific HUMINT threat post. The contractor should immediately coordinate with DS/IS/IND to initiate the appropriate Diplomatic Security (DS) reviews for those individuals who are proposed to deploy to those posts.

1) Personnel traveling to specific HUMINT threat posts for short-term visits (less than 60 days cumulative in a “12-month period” for all posts) must have a minimum FINAL SECRET clearance and a favorable DS name check prior to deployment. INTERIM SECRET clearances are not acceptable for such travel. DS name checks will be conducted in conjunction with electronic country clearance request processing.

2) Personnel traveling in excess of 60 days must possess a final TOP SECRET personnel security clearance, based on a Single Scope Background Investigation (SSBI) conducted within the past five years, and undergo a DS Acceptability Review (A/R) and DS name check prior to approval for deployment. Personnel currently undergoing SSBI-Periodic Reviews (5 year updates) with Defense Security Service are not eligible for an A/R and should not be nominated for long-term assignment to HUMINT threat posts until their SSBI-PR has been favorably adjudicated and an updated Visit Authorization Request (VAR) submitted.

3) For those personnel who do not have a previous A/R, the contractor will be invited by DS/IS/IND to electronically submit the A/R via the Office of Personnel Management’s Electronic Questionnaire for Investigation Processing (e-QIP). e-QIP is a secure website that can be accessed from any computer system that has an Internet connection. In order to begin this process, the following information must be submitted by the Facility Security Officer, via email to DS_IND_OBOTeam@state.gov

SUBJECT Line of email: Acceptability Review for LAST, First-Country

Name Social Security Number Date of Birth and Place of Birth

Job Title Email address City/country for this trip

4) Upon receipt of the above, DS/IS/IND will:

initiate a DS name check to determine whether the individual could be eligible for deployment while the Acceptability Review is pending, initiate the Acceptability Review with DS/SI/PSS, notify the contractor and the COR of interim approval for deployment while results of the A/R are pending. Conversely, notify the contractor and the COR of interim denials. In these cases, deployment cannot begin until the A/R is favorably adjudicated, and notify the COR and contractor of the final results, upon adjudication of the A/R.

5) DS/IS/IND maintains a record of previous A/Rs and deployment records to specific HUMINT threat posts and will determine if a previous A/R is still valid for deployment. For those individuals who have a valid A/R, DS/IS/IND will accomplish the following:

DS Name Check Notify the contractor and the COR of approval/disapproval for deployment

6) Personnel approved for deployment while an A/R is pending can be immediately deployed. However, if the Acceptability Review is ultimately adjudicated unfavorably, upon notification by the COR, the individual must be immediately removed from the post at no expense to the U.S. Government.

7) Personnel not approved for immediate deployment may be assigned to non-specific HUMINT threat posts until the A/R has been completed and adjudicated. If the Acceptability Review is unfavorably adjudicated, the individual will not be authorized for future deployments to specific HUMINT threat posts, and may not be authorized for further performance on this contract.

mailto:DS_IND_OBOTeam@state.gov mailto:DS_IND_OBOTeam@state.gov