Appendix D - Bidders DD-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PREVIOUS EDITION IS OBSOLETE.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DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE.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

Unclassified

Unclassified

Industrial Security Management System

Secret None

c. SOLICITATION NUMBER

19FS1A-22-R-0002 20220625

✔ 20220425

X

X

Department of State locations

19AQMM

Administrative and Professional Services (FSI TAPS)

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)

Unclassified

Unclassified

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

✔ MRPT's are AUTHORIZED

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.)

Unclassified

Unclassified

Industrial Security Management System

Fannie C. Gillespie, DCSS Principal Team Lead

See Moderate Risk Public Trust (MRPT) procedures attachment

X

Department of State

19AQMM

2201 "C" Street, NW Washington, DC 20520

Michael Hawk

571-345-3022

HawkM@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 a SECRET personnel security clearance, commensurate with their level of access, issued by the Defense Counterintelligence and Security Agency (DCSA), prior to contract performance. Uncleared individuals specifically authorized by the Contracting Officer's Representative (COR) to perform on-site in DOS facilities, only on unclassified portions of the contract and/or in areas not requiring cleared access must still be processed for DOS personal identification cards (badges) in accordance with the DOS Personal Identification Card Issuance Procedures.

Contractor personnel specifically designated by the Contracting Officer's Representative (COR) will be required to have a Moderate Risk Public Trust (MRPT) determination conducted by the Bureau of Diplomatic Security.

Visit Authorization Requests (VAR) are to be sent to Department of State (DOS), DS/IS/IND, Washington, DC 20520, via email: DS_IND_contractorVARS@state.gov. A VAR is valid for 12 months; an updated VAR is required 30 days prior to the current VAR expiring.

All DD Forms 254 for proposed subcontractors required to provide cleared personnel shall be forwarded to DS/ IS/IND for generation and certification prior to issuance to the subcontractor and prior to access to any classified information or controlled access areas. Proposed subcontractors must be reviewed by DS/IS/IND prior to contract performance. The prime contractor shall provide a current signed (by both parties) Subcontract Agreement (with subcontract number listed) between the entities outlining specific Scope of Work (SOW) to be performed by the subcontractor, to include all security requirements.

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) (32 CFR Part 117) 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/CTS.

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.

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 12 FAM 275.

Classified storage is not required for performance on this contract; therefore, no discussion, storage, or generation of classified information shall take place at the contractor's facility.

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

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

CO (DOS/FSI/EX/ACQ): Dudley L. Greene / (703) 746-2325 / GreeneDL@state.gov

COR (DOS/FSI/EX/GSO): Larry D. Parks / (703) 746-2338 / ParksLD@state.gov

GTM (DOS/FSI/EX/GSO): Francis E. Shields / (703) 746-2969 / ShieldsFE@state.gov

13. SECURITY GUIDANCE.

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

DS/IS/IND Point of Contact: Christopher A. Taylor / (571) 345-3030 / TaylorCA2@state.gov

MODERATE RISK PUBLIC TRUST (MRPT) PROCEDURES

Contractor personnel requiring a MRPT prior to assignment to this contract/task order shall contact the Industrial Security Division (DS/IS/IND) at 571-345-3019, or DSISINDqueries@state.gov and provide required employee information. This information will be used to establish a link to the e-QIP web site for access. Once the link is established, the employee will fill out the SF-85P and SF-85PS online via e-QIP and submit electronically. The employee must also submit the following: a signed Drug Certification document, (2) completed FD-258

Fingerprint cards, a signed Fingerprints Privacy Statement, and proof of citizenship or Employment Authorization Card (unexpired). Fingerprints can be sent electronically if company has the equipment to process them. These forms and a request letter on company letterhead should be forwarded to the Industrial Security

Division (DS/IS/IND), Bureau of Diplomatic Security, 1801 North Lynn Street, SA-20, 13th Floor, Rosslyn, VA 22209-2008. Send all documents and fingerprint cards to DS/IS/IND via FedEx, UPS, or one of the other commercial delivery carriers. Do not use the U.S. Postal Service.

NOTE: DS/SI/PSS cannot conduct concurrent investigations. If the applicant has an investigation underway with another agency; OPM, DCSA, etc., the application will be rejected.

DS/SI/PSS will conduct preliminary background checks in conjunction with the

MRPT determination; if favorable, the individual will be granted an interim-MRPT and is authorized contract/task order performance while their final MRPT is pending. An individual, who does not pass the initial background checks, will be denied an interim-MRPT and is NOT authorized assignment to the contract/task order until they receive a favorably adjudicated final-MRPT determination. If the contractor does not receive a favorable final-MRPT determination, the company must remove the individual from the contract/task order at no cost to the government. After receiving the initial favorably adjudicated final-MRPT determination, DS/SI/PSS may require an applicant to undergo periodic reinvestigation for continued contract/task order performance.

The Facility Security Officer (FSO), or designated company security point of contact must notify DS/IS/IND when an employee terminates or resigns from the contract/task order. DS will terminate their access to all facilities. In addition, DS/IS/IND will cancel the MRPT investigation, if still pending.

NOTE: Contractor employees possessing personnel security clearances assigned to this contract requiring MRPT determinations must be processed for transition to the MRPT via reciprocity. For reciprocity, the contractor employee must provide a completed “Revalidation of Moderate Risk Public Trust

Certification (MRPT) Or Reciprocity of Personnel Security Clearance (PCL) for

MRPT” form. A copy of the required form will be provided upon request. The contractor must also provide a signed Drug Certification form. Reciprocity must be granted before contract performance.

Note: In order to meet the criteria for Revalidation/Reciprocity, subjects holding security clearances/MRPTs must meet the following criteria:

1. Served continuously (in access of something: clearance or public trust) for at least 1 year;

2. Any break in service must be less than 24 months;

3. The level requested is same or lower than what was previously determined;

4. No developed information.

The FSO Facility Security Officer (FSO), or designated company security point of contact shall report any adverse information pertaining to contractor employees performing on the contract/task order.

Security requirements for contractors accessing the Department’s domestic or overseas unclassified information systems shall be in accordance with 12 Foreign

Affairs Manual Section 600 (12 FAM 600).

Address any questions or concerns to DS/IS/IND at 571-345-3019, or

DSISINDqueries@state.gov.