19AQMM-20-R-0064 - BIDDERS DD Form 254.pdf

CLASSIFICATION (When filled in):

PREVIOUS EDITION IS OBSOLETE. Page 1 of 3 AEM LiveCycle Designer

DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE. Page 1 of 3 AEM LiveCycle Designer

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

Industrial Security Management System

Secret None

c. SOLICITATION NUMBER

19AQMM-20-R-0064

✔ 20200110

X

X

INL/WHP Monitoring and Evaluation (M&E) Support

PREVIOUS EDITION IS OBSOLETE. Page 2 of 3 AEM LiveCycle Designer

DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE. Page 2 of 3 AEM LiveCycle Designer

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)

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. ]

PREVIOUS EDITION IS OBSOLETE. Page 3 of 3 AEM LiveCycle Designer

DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE. Page 3 of 3 AEM LiveCycle Designer

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.)

Industrial Security Management System

George Ranly, Industrial Security Specialist

X

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.

This is a BIDDERS DD Form 254.

The Contractor shall possess and maintain a SECRET Facility Security Clearance issued by the Defense Counterintelligence and Security Agency (DCSA) in accordance with the National Industrial Security Program Operating Manual (DOD 5220.22-M) for the duration of this contract. If necessitated by contract requirements, the Contractor must ensure that Subcontractors maintain the appropriate facility security clearances.

Contractor personnel performing in specifically designated positions (CLINs) require U.S. citizenship and a SECRET personnel security clearance issued by the Defense Counterintelligence and Security Agency (DCSA) prior to contract performance.

All U.S. citizen personnel that do not require a personnel security clearance for contract performance and all Third Country National (TCN) personnel must possess a Moderate Risk Public Trust (MRPT) certification granted by the Bureau of Diplomatic Security (DS/SI/PSS) prior to contract performance.

All Local National (LN) personnel shall be vetted by the host country Regional Security Officer (RSO) in accordance with local standards, prior to contract performance. The contractor shall coordinate with the RSO for vetting requirements. Results shall be reported to the CO/COR, the Program Office, and the Contractor's Facility Security Officer. If a favorable determination is not rendered, the Candidate shall not perform under this Contract.

The level of security vetting required for specific labor categories or CLINs shall be in accordance with contract requirements.

Visit Authorization Requests (VAR) for all cleared personnel performing on this DOS contract are to be sent to Department of State (DOS), DS/IS/IND, Washington D.C. 20520, via email: DSIND_PSD@state.gov or via fax:

571-345-3000. A VAR is valid for 12 months. A renewal VAR must be submitted 30 days prior to current VAR expiration for as long as the individual is continually performing on contract. Update VARs are required when cleared personnel have a change to access level. A VAR cancellation must be submitted when cleared personnel are no longer performing on contract or no longer require access to classified. The Facility Security Officer (FSO) shall submit VAR cancellations within 72 hours of contract departure to DSIND_PSD@state.gov. The FSO shall also submit cancellation notifications within 72 hours when personnel issued a public trust certification depart contract performance.

All DD Forms 254 for proposed subcontractors shall be forwarded to DS/IS/IND for certification and generation by DS/IS/IND prior to issuance to the subcontractor and prior to access to any classified information or controlled access area (CAA spaces). All requests for subcontractor DD Forms 254 shall be forwarded to DSIND_PSD@state.gov. DD Forms 254 issued by DS/IS/IND will be forwarded to the prime for distribution to subcontractors. Contractors are not authorized to issue their own subcontract DD Forms 254.

While at DOS locations, the contractor shall comply with applicable DOS regulations relative to 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. DS/IS/IND is responsible for reviewing contractors assigned to DOS locations.

Security clearance requirements for contractors accessing DOS domestic or overseas information systems shall be in accordance with 12 FAM 600. Furthermore, citizens of specifically designated human intelligence and/or technical intelligence threat countries shall not develop, modify or perform maintenance on software developed for use on DOS computer systems without approval by DS/SI/CS.

13. SECURITY GUIDANCE.

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

FSOs are required to implement a briefing and reporting program for cleared contractors in accordance with the NISPOM and as detailed in the contract documents to cover all reporting requirements, as well as information handling and travel overseas.

Contractors 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. Contractors shall immediately report any adverse information concerning any contractor employees vetted by the Department of State for contract performance to DS/IS/IND in accordance with the contract documents and 12 FAM 270.

Contractor personnel working on DOS contracts must immediately report intent to marry, cohabitation and other continuing bonds of affection with non-US Citizens to the COR and DS/IS/IND, in accordance with 12 FAM 275.

DCSA approved safeguarding is not required for performance on this contract; therefore, no discussion, generation, or storage of classified information shall take place at the contractor's facility. All access to classified shall take place at DOS facilities.

SBU Information: See 12 FAM 540 for guidance regarding the Handling, Access, Dissemination, and Release of

SBU.

As per DOSAR 652.204-70: The Contractor shall comply with the Department of State (DOS) Personal Identification Card Issuance Procedures for all employees performing under this contract who require frequent and continuing access to DOS facilities, or information systems.

All FAM references can be viewed on the DOS website, www.state.gov

CO (A/OPE/AQM): Stephanie Reid-Smith / 703-493-2561 / Reid-SmithSJ@state.gov

DS/IS/IND Point of Contact: George Ranly / 571-345-3018 / RanlyGeorge@state.gov DS/IS/IND Alternate POC: Kimberly Iverson / 571-345-7964 / IversonKD@state.gov