J.1.a.5 - DRAFT DD254 ATOM-5.pdf
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- Attached to
- Aerospace Testing and Facilities Operations and Maintenance (ATOM-5) Federal contract opportunity
- Solicitation number
- 80ARC021R0001
About this file
This document contains a draft DD Form 254 for a classified contract and information about an upcoming Aerospace Testing and Facilities Operations and Maintenance solicitation. The draft DD Form 254 provides security classification guidance for a contract requiring access to Special Access Program information at the Secret level. It identifies required security clearances, controlled unclassified information requirements, and points of contact for classification guidance and public release of information. The related federal contract opportunity notice announces NASA/ARC's plan to issue a Request for Proposal for the Aerospace Testing and Facilities Operation and Maintenance acquisition. The solicitation will provide support services for testing, facility operations, and maintenance at NASA Ames Research Center. The work includes aerospace testing, development and operation of support facilities, and administration. The notice provides details on NAICS code, size standard, anticipated solicitation release and amendment dates, and points of contact for questions.
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DRAFT
SAMPLE
PREVIOUS EDITION IS OBSOLETE.
Page of
DD FORM 254, MAY 2019
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:
20220531 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.)
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 whs.mc-alex.esd.mbx.formswebmaster@mail.mil
WHS
List of Attachments (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form)
| CurrentPage: |
| PageCount: |
| Classification: Unclassified |
| SerialNum: |
| a. Facility clearance level. Select one.: 2 |
| b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 4 |
| Choose Yes or No: 1 |
| Choose Yes or No: 1 |
| Prime: Request for proposal |
| Choose Yes or No: 0 |
| Choose Yes or No: 0 |
| Sub: |
| Choose Yes or No: 0 |
| Choose Yes or No: 0 |
| Soli: |
| DueDate: |
| dateA: |
| RevisionNum: |
| dateB: |
| Final: |
| dateC: |
| No: 0 |
| No: 1 |
| No: 0 |
| No: 0 |
| Yes: 1 |
| Yes: 0 |
| Yes: 1 |
| Yes: 1 |
| Enter your name here.: NNA16BD26C |
| ReqDated: |
| Enter your name here.: |
| Name: Request for proposal |
| Name: LaGrande, Sara |
| Cage: N/A |
| CSO: |
| CSO: Protective Services Office |
Bldg 15, MS: 15-1 Moffett Field, CA 94035
| addrow: |
| Removerow: |
| Click to delete a row: |
| Location: NASA Ames Research Center |
Moffett Field, CA 94035-1000 Block9:
SUPPORT FOR AEROSPACE TESTING AND FACILITIES OPERATIONS, MAINTENANCE, AND REPAIR SERVICES FOR NASA-ARC TESTING AND SUPPORT FACILITIES
| a: 0 |
| a: 1 |
| a: 1 |
| f: 1 |
| f: 0 |
| f: 1 |
| b: 0 |
| b: 0 |
| b: 0 |
| g: 0 |
| g: 0 |
| c: 0 |
| c: 0 |
| c: 1 |
| h: 0 |
| h: 0 |
| d: 0 |
| d: 0 |
| d: 0 |
| i: 0 |
| i: 0 |
| SCI: 0 |
| NonSCI: 0 |
| j: 0 |
| j: 0 |
| k: 1 |
| k: 0 |
| Enter your name here.: CONTROLLED UNCLASSIFIED INFORMATION (CUI) |
| Enter your name here.: Contracting Officer Representative (COR) |
| e: 0 |
| e: 1 |
| l: 0 |
| m: 0 |
| direct: 0 |
| thru: 1 |
| Enter your name here.: External Affairs Office NASA Ames Research Center, M/S 204-2 Moffett Field, CA 94035 |
| PublicAuthority: Office of Public Affairs, NASA Headquarters, Washington, DC 20546 |
| AddSig: |
| RemoveSig: |
| text: 10f. This contract will require access to special access program information and the NASA COR will specify which positions require SAP access. As such, personnel security investigative requirements are enhanced, as referenced in the NASA Special Access Program Security Guide. When contractor positions are specified by the NASA COR as needing access to special access program information, the Contractor will ensure that the necessary personnel possess and maintain, at minimum, a SECRET clearance based on a NACLC, T3, or T3R investigation, conducted and current within a six year scope. If the investigation is outside of that scope, NASA will accept if the personnel are enrolled in the DoD Continuous Evaluation program provided the reason for enrollment is "deferred," or similar wording. |
10k. For all unclassified technical material defined as Controlled Unclassified Information, the Contractor shall comply with NASA Interim Directive (NID) 2810.135, and subsequent revisions.
11a. Contract performance is limited to NASA Ames Research Center, Moffett Field, CA. For Classified National Security Information, the Contractor shall comply with NASA Procedures and Requirements (NPR) 1600.1A and NPR 1600.2A, and subsequent revisions; NASA ARC specific security procedures and guidance; and the 32 CFR Part 117, National Industrial Security Program Operating Manual (NISPOM). NASA will provide complete classification guidance for the services to be performed. The COR and/or Task Requester will provide this guidance directly to the Contractor's on-site employees performing the classified work. The COR will also specify which positions require security clearances and at which level.
| attachmentsList: |
| AddAttachment: |
| ViewAttachment: |
| RemoveAttachment: |
| rep: Sara LaGrande, SSO |
| Sig: |
| Enter your name here.: Safeguard all information in accordance with NASA Procedural Requirement (NPR) 1600.1 and NASA Ames Research Center Procedural Requirement (APR) 1620.1 |
| Enter your name here.: Safeguard all information in accordance with NASA Procedural Requirement (NPR) 1600.1A, NPR 1600.2A and NASA Ames Research Center Procedural Requirement (APR) 1620.1 |
| GCAName: |
| AAC: 809190 |
| Address: NASA ARC |
Bldg 233 M/S 233-17 Moffett Field, CA 94035-1000
| POCName: |
| Phone: 6506041978 |
| Email: |
| Title: Special Security Officer |
| Enter the date using the format DD-Mon-YYYY: 20210426 |
File details come from the government source that posted it. Updated .