254.pdf

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Attached to
F-16 Advanced Avionics (LRUs) Federal contract opportunity
Solicitation number
FA825123R0003
Issued by
Department of the Air Force Materiel Command Air Force Sustainment Center

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DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of

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:

May 31, 2022 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.)

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

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"

CurrentPage:
PageCount:
Select classification from drop-down list.: Unclassified
SerialNum:
a. Facility clearance level. Select one.: 2
b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 2
Select for "original.": 1
Select for "original.": 1
Enter prime contract number.: FA8251-18-D-0011
Select for "revised.": 0
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Select for "final.": 0
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Enter solicitation or other number.:
Enter due date in format YYYYMMDD.:
Enter date in format YYYYMMDD.: 20220215
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Select for "no.": 0
Select for "no.": 1
Select for "no.": 0
Select for "no.": 1
Select for "yes.": 1
Select for "yes.": 0
Select for "yes.": 1
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Enter preceding contract number.: FA8251-18-D-0010
Enter contractor's request date in format YYYYMMDD.:
Enter period.:
Enter typed name of certifying official (last, first, middle initial).: INTERNATIONAL ENTERPRISES, INC. (IEI)

108 Allen St.

Talladega, AL 35160 (Classified Mail: Attn: Facility Security Officer, P.O. Box 6213 Talladega, AL 35161)

Enter CAGE code of the prime contractor.: 50218
Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: Defense Security Service (IOFSA)

1899 Powers Ferry Road, Suite 330 Atlanta, GA 30339 Main: 770-635-0455 Email: dss.atlantafieldoffice@mail.mil

Select to add row to locations.:
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Select to delete all signatures.:
Enter location(s).: See item 6.a -6.c
Enter general unclassified description of this procurement.: Purchase of essential re-manufacture of the ACPDG, ACMFD, and CCIU line replaceable units.
Select for "a. CONTRACTOR.": 0
Select for "a. CONTRACTOR.": 0
Select for "a. CONTRACTOR.": 0
Select for "f. OTHER AS NECESSARY.": 0
Select for "f. OTHER AS NECESSARY.": 0
Select for "f. OTHER AS NECESSARY.": 0
Select for "b. SUBCONTRACTOR.": 0
Select for "b. SUBCONTRACTOR.": 0
Select for "b. SUBCONTRACTOR.": 0
Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0
Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0
Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0
Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 1
Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0
Select for "h. REQUIRE A COMSEC ACCOUNT.": 0
Select for "h. REQUIRE A COMSEC ACCOUNT.": 0
Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0
Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 1
Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0
Select for "i. HAVE A TEMPEST REQUIREMENT.": 0
Select for "i. HAVE A TEMPEST REQUIREMENT.": 0
Select for "e. NATIONAL INTELLIGENCE INFORMATION: - (1) Sensitive Compartmented Information (SCI).": 0
Select for "e. NATIONAL INTELLIGENCE INFORMATION: - (2) Non-SCI.": 0
Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1
Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1
Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0
Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0
Enter infomration for "other.":
Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0
Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0
Select for "l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI). .": 1
Select for "m.OTHER.": 0
Select for "direct.": 0
Select for ": 1
Enter specification for "through".: 75 ABW Public Affairs Office, 7981 Georgia Street, Hill AFB, UT 84056 (801-777-5201)
Enter public release authority.: SAF, Public Affairs (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330-1690 (703-571-5370)
Select to add signature.:
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text: Ref. 10.j.: FOUO 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 11.c.: The contractor requires access to classified source data up to and including SECRET in support of the work effort. All classified information received or generated will be properly stored and handled according to the markings on the material. Contractor will abide by the following security classification guidance: F-16 Multimission Fighter 1 June 2006 (Revised 2 March 2016). The applicable SCG will be provided under a separate cover. At the termination or expiration of this contract, the U.S. Government will be contacted for proper disposition instructions.

Ref 11d. Contractor shall provide adequate storage for classified hardware and materials to the level of SECRET which exceeds 2 cubic feet but not more than 250 cubic feet and is of size and quantity that cannot be safeguarded in a General Service Administration (GSA)-approved security container.

Ref 11.l. In accordance with DFARS Subpart 252.204-7012, contractors and subcontractors will safeguard covered defense information that resides in or transits through contractor information systems by applying specified network security controls, and will report cyber incidents.

13.a: Program Manager: Shannon McAffee 416 SCMS/GUMAC (801) 777-6637 13.b: DD FM 254 Review -

Click on this button to attach a file(s).:
rep:
Enter signature.:
Explain and identify specific areas and government activity responsible for inspections.: Ref 11.j. The contractor must comply with the U.S. Government, DOD, Air Force, AFMC, Hill AFB, and 416 SCMS Operation Security (OPSEC) Programs. The contractor must comply with any additional OPSEC requirements referenced in attachment within Item 13.
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File details come from the government source that posted it. Updated .