Bidders_19-R-0002.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PREVIOUS EDITION IS OBSOLETE.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DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE.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

Top Secret None

c. SOLICITATION NUMBER

19FJ60-19-R-0002

✔ 20190530

X

X

To provide maintenance services for York Air Cooled Rotary Chillers and associated air handling units at the U.S.

Embassy in Suva, Fiji Islands

BIDDERS

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 AT DOS LOCATIONS ONLY

DEPARTMENT OF STATE, 2201 'C' ST WASHINGTON

DC 20520 DS/IS/IND

[ 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

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

Additional Security Requirements Attachment

X

Department of State

19AQMM

2201 C. St. NW Washington, DC 20520 Kimberly Baugher

571-345-3032

BaugherK2@state.gov for Kimberly A. Baugher

Division Chief

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

2201 C St.

Washington, DC 20520

19FJ60

571-345-3032

BaugherK2@state.gov

13. SECURITY GUIDANCE.

DD FORM 254, SECURITY GUIDANCE Page 4 of 4 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 deploying to site and requiring access to classified information or to Controlled Access Areas (CAAs) must possess a Top Secret security clearance issued by DSS. Personnel requiring access to existing core spaces and core system support equipment/spaces will require Final Top Secret clearances.

Visit Authorization Requests (VARs) for all cleared personnel performing on the contract at DoS locations are to be sent to DS/IS/IND via e-mail to DSINDOBOVARS@state.gov (with the DS/IS/IND POC copied) or faxed to 571-345-3000.

Requests for DD Forms 254 for subcontracts shall be forwarded to DS/IS/IND via e-mail to DS_IND_OBOTeam@state.gov, prior to subcontractor access to any classified information or CAA spaces. DD Forms 254 issued by DS/IS/IND will be forwarded to the prime for distribution to subcontractors.

The contractor shall be responsible for security classification review of all test/trip results, and marking, safeguarding and handling of all contract deliverables developed and submitted under the purchase order in accordance with the Security Classification Guide for the Design and Construction of Facilities Overseas, dated July 2018. All material generated by the contractor shall be classified in accordance with the Security Classification Guide (SCG) for the 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.

Any classified information generated by technicians at post will be generated on post provided equipment in secure spaces. The equipment and space for generating classified reports will be coordinated by the Facilities Manager or Regional Security Office and will be delivered, via secure means, by the FM/RSO, to the OBO COR.

DSS approved safeguarding is not a requirement; therefore, no discussion, generation or storage of classified information shall take place at their facility. However, the SCG shall be utilized for identification and handling of SBU and SBU/NOFORN at the contractor's facility and handling of classified information at DoS locations.

The loss, compromise, or suspected compromise of any classified or SBU information regarding this project 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.

While at DoS locations, the contractor shall comply with applicable DoS regulations relative to the protection of classified and/or sensitive information, including the NISPOM and Section H.

Contractors shall immediately report any adverse information concerning any cleared contractor employees performing on DoS contracts to DSS, in accordance with the NISPOM and DS/IS/IND, in accordance with Additional Security Requirements Section 2, Para. 6.

Contractor personnel working on DoS contracts must report impending marriage, cohabitation and other continuing bonds of affection with foreign nationals to the COR and DS/IS/IND, in accordance with Additional Security Requirements Section 2, Para. 7.

CO (Suva MGT/GSO): Eric T. Vogel / +6793314466 / VogelET@state.gov COR (Suva MGT/FAC): Stephen Moran / +6793314466 / MoranS2@state.gov DS/IS/IND Point of Contact: Elena Chamberlain / 571-345-2252 / Chamberlainem@state.gov