ATCH 2_NITE-STAR CD IDIQ_DD254_20260312_FINAL.pdf

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PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, APR 2018

NEEDS DD67

(Updated 20250815)

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:

August 31, 2028 The public reporting burden for this collection of information, 0704-0567, is estimated to average 36 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 Form 254, "DoD Contract Security Classification Specification"

(See Instructions) - Select from drop-down list: 1

TBD

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):

NA

XXXX Field Office Street Address City, State ZIP Phone, DCSA_email address@mail.mil

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional):

NA

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): DCSA Huntsville Field Office 1525 Perimeter Parkway NE Huntsville, AL 35806; (256) 801-3480 dss.dss-southern.dss-isfo.mbx.huntsville-fieldoffice@ mail.mil

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): DCSA Colorado Springs Field Office 2060 Briargate Parkway, Suite 220 Colorado Springs, CO 80920-7660, (719) 419-3150, dcsa.dcsa-western.dcsa-isfo.mbx.colorado-springs-fieldoffice@

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): DCSA Colorado Springs Field Office 2060 Briargate Parkway, Suite 220 Colorado Springs, CO 80920-7660, (719) 419-3150, dcsa.dcsa-western.dcsa-isfo.mbx.colorado-springs-fieldoffice@

2060 Briargate Parkway, Suite 220 Colorado Springs, CO 80920-7660, (719) 419-3150, dcsa.dcsa-western.dcsa-isfo.mbx.colorado-springs-fieldoffice@mail.mil

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): DCSA Colorado Springs Field Office 2060 Briargate Parkway, Suite 220 Colorado Springs, CO 80920-7660, (719) 419-3150, dcsa.dcsa-western.dcsa-isfo.mbx.colorado-springs-fieldoffice@mail.mil

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): Defense Counterintelligence and Security Agency Colorado Springs Field Office - IOFWC 2060 Briargate Pkwy, Ste 220, Colorado Springs, CO 80920 Phone: 719.419.3150; Email: dcsa.dcsa-western.

dcsa-isfo.mbx.colorado-springs-field-office@mail.mil

1777 NE Loop 410, Suite 801 San Antonio, TX 78217: (210) 810-4495 dss.dss-southern.dss-isfo.mbx.san-antonio-fieldoffice@ mail.mil

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): Defense Counterintelligence and Security Agency - Cypress Field Office (IOFWH) 10801 Walker Street, Suite 240, Cypress, CA 90630 Phone: (714) 822-3100; Email: dcsa.dcsa-western.dcsa-isfo.mbx.cypress-field-office@mail.mil

5030 Bradford Drive, Bldg 2, Suite 205 Huntsville, AL 35805-1923

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): HQ STARCOM ENSCO, Plaza of the Rockies 121 S. Tejon St, Suite 1000, Rm 10030 Colorado Springs, CO 80903

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): HQ STARCOM

ENSCO

1050 North Newport Rd, Rms 206 and 207 Colorado Springs, CO 80916

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): HQ STARCOM 150 Vandenberg Street, Bldg 1 Peterson SFB, CO 80914

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): HQ SpOC 150 Vandenberg Street, Suite 1105 Bldg 1470 and Bldg 1 Peterson SFB, CO 80914

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): Delta 1/319 CTS 236 Paine Street, Building 1876 Peterson SFB, CO 80914

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): Delta 11/25 SRS/98 SRS/33 SRS 24 Talon Way Bldg 24, Rooms 2001-2013 Schriever SFB, CO 80912

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): Delta 12/3 TES 400 O'Malley Avenue, Suite 55 Bldg 400, Mod 16 Schriever SFB, CO 80930

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): Aerospace Corporation, The 7250 Getting Heights Colorado Springs, CO 80916

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): MITRE Corporation 1155 Academy Park Loop Colorado Springs, CO 80910

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): Exigo Corporation 2424 Garden of the Gods Rd Ste 120 Colorado Springs CO 80919

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): HQ STARCOM 1925 Aerotech Drive, Suite 224 Colorado Springs, CO 80916

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): Hewlett Packard Enterprise Company 1701 East Mossy Oaks Road Spring, TX 773

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): SAIC Maple Facility (SpaceDEN M3) 1925 East Maple Ave.

El Segundo, CA 90245

The Operational Test and Training Infrastructure (OTTI) and System Delta 81 (SYD 81) mission is to provide space warfighters interconnected, scalable, and distributed live/physical and synthetic/digital ranges for full-spectrum test and training to develop, validate, and sharpen joint warfighting solutions to prevail in Multi-Domain Operations (MDO) conflicts. The National Space Test and Training Complex (NSTTC) Innovative Technology & Engineering – Space Test and Range (NITE-STAR) Capability Development Multiple-Award (MA) Indefinite-Delivery, Indefinite-Quantity (IDIQ) base contract vehicle will be used to design and develop complex end-to-end systems which are space-based and/or ground-based systems and their associated control systems.

SSC SSO

SSC IPO

forwarded by entry level PA office via MAJCOM/DRU PA Office.

12. PUBLIC RELEASE - Public Release Authority:: SECAF, Office of Public Affairs, Security & Review Division (SAF/PAX), 1670 Air Force Pentagon, Washington DC20330-1670

Level of SCI Access: TS//SCI SCI Addendum (Attachment 1) (CUI)

Ref block 8a: See SCI addendum for additional performance locations for SCI level work.

Ref Block 10a: Access to classified COMSEC information requires a final U.S. Government clearance at the appropriate level. Further disclosure of COMSEC information by a contractor, to include subcontracting, requires approval of the GCA. Non-accountable COMSEC information, though not tracked in the COMSEC material control system, may still require a level of control within a document control system. Refer to NSA/CSS Manual 3-16, “Control of Communications Security Material,” and the Committee on National Security Systems Instruction (CNSSI) 4001, “Controlled Cryptographic blocks,” for guidance. If access to COMSEC information is required at Government facilities, or the material is under Government control, contractor personnel will follow the security requirements of the host government activity. AFMAN 17-1302-0, Communications Security (COMSEC) Operations, 2 Apr 20 and MPTO 00-33B-5001, AF Accounting COMSEC Procedures.

Ref Block 10e(1)(2): Contractor employee’s access to SCI and Non-SCI information will be at the place(s) of work identified in the SCI addendum. Contractor material marked as “ORCON”, “PROPIN”, “NOFORN”, or “REL TO” may be released to the contractor by the contract monitor only under provision of ICD 704. The controls and definitions specified in ICD 703 are applicable to the contract. The CSSO must ensure all contractor employees who have access to this material are fully trained in the ICD 703 requirements. The CSSO must provide a list of contractor personnel who have need-to-know for this information and the contract monitor must validate need-to-know by signature before the contractor employee has access to this information. SCI Billets will be kept to a minimum. See SCI Addendum.

Ref 10g. Special briefing are required for access to NATO IAW DoDM5200.01 Volume 1_AFMAN 16-1404 Volume 1. Prior approval of the contracting activity is required for subcontracting. Access to classified NATO information requires a final U.S. Government clearance at the appropriate level.

Ref Block 10j: The contractor shall comply with DoDI 5200.48_DAFI16-1403, Controlled Unclassified Information, DoDM 5200.01, Vol 1_AFMAN16-1404, Vol 1, Air Force Information Security Program, and DoDM 5400.07_AFMAN33-302 Air Force Manual, DoD Freedom of Information Act (FOIA) Program. The contractor shall monitor CUI aggregation and compilation based on the potential to generate classified information pursuant to security classification guidance addressing the accumulation of unclassified data or information.

a. For JWICS and/or other SCI systems: The government will only provide JWICS and/or access to other SCI systems to include e-mail and web access provided the contractor meets ALL SCI eligibility and training requirements and maintains the appropriate SCI access level. Contractors will be held strictly accountable for all actions they initiate on the network and will conduct business IAW HQ SSO USSF, and local base instructions and policies. Privileges will be terminated if contractor does not maintain a current TS investigation.

b. STE access is required for contract performance: Access will be controlled by the sponsoring agency. Contractor will follow requirements IAW AFMAN 17-1302-O, Communications Security (COMSEC) Operations.

Ref Block 11d: The contractor is required to provide adequate and approved storage for classified hardware or material to the level of (TOP SECRET/SECRET/CONFIDENTIAL), which because of size or quantity, cannot be safeguarded in an approved storage container.”

Ref Block 11j: The contractor shall comply with OPSEC requirements referencing AFI 10-701 Operations Security (OPSEC) and AFI 35-102 Security and Policy Review Process for guidance and/or direction. The contractor shall adhere to OPSEC guidance and be familiar with the organization’s/weapon’s system Critical Information and Indicator List (CIIL) and ensure indicators & vulnerabilities are protected from disclosure per organization’s/weapon’s system countermeasures/measures. The contractor shall complete OPSEC inprocessing/ initial training to include follow on OPSEC training such as event-driven and annual OPSEC training as required. OPSEC training will be provided by the respective unit OPSEC Program Manager (PM)/Planner/Coordinator. To obtain OPSEC training or ask OPSEC related questions contact the respective unit OPSEC PM/Planner/Coordinator. The USSF OPSEC PM/Planner can be reached over respective automated-information systems. The following link contains OPSEC POCs for each unit: https://intelshare.intelink.gov/sites/ usspacecom-io/_layouts/15/start.aspx#/Lists/Roster/AllItems.aspx. The contractor is not responsible to develop an OPSEC plan.

Ref Blk 11i: EMSEC requirements apply to the SCIF execution location. See DFARS 252.239-7000, Intelligence Community (IC Tech Spec‐for ICD/ICS 705), Technical Specifications for Construction and Management of Sensitive Compartmented Information Facilities, version 1.5, dated 13 March 2020; Committee on National Security Systems Advisory Memorandum (CNSSAM) TEMPEST/01-13, Red/Black Installation Guidance, dated 17 January 2014.

Any request for SCI/SCIF building, please contact the SSO office Physical Security team for forms and approval SSO.ssc.physical.security@spaceforce.mil

Ref Block 11l: DFARs clause 252.204-7000, DISCLOSURE OF INFORMATION (OCT 2016)

(a) The Contractor shall not release to anyone outside the Contractor's organization any unclassified information, regardless of medium (e.g., film, tape, document), pertaining to any part of this contract or any program related to this contract, unless—

(1) The Contracting Officer has given prior written approval;

(2) The information is otherwise in the public domain before the date of release; or

(3) The information results from or arises during the performance of a project that involves no covered defense information (as defined in the clause at DFARS 252.204-7012) and has been scoped and negotiated by the contracting activity with the contractor and research performer and determined in writing by the contracting officer to be fundamental research (which by definition cannot involve any covered defense information), in accordance with National Security Decision Directive 189, National Policy on the Transfer of Scientific, Technical and Engineering Information, in effect on the date of contract award and the Under Secretary of Defense (Acquisition, Technology, and Logistics) memoranda on Fundamental Research, dated May 24, 2010, and on Contracted Fundamental Research, dated June 26, 2008 (available at DFARS PGI 204.4).

(b) Requests for approval under paragraph (a)(1) shall identify the specific information to be released, the medium to be used, and the purpose for the release. The Contractor shall submit its request to the Contracting Officer at least 10 business days before the proposed date for release.

(c) The Contractor agrees to include a similar requirement, including this paragraph (c), in each subcontract under this contract.

Subcontractors shall submit requests for authorization to release through the prime contractor to the Contracting Officer.

Ref Block 11m: The Contractor will notify the government when so directed and/or specified by provisions in this DD FORM 254, related contract and/or related clauses, attachments, addendums, etc. The Contractor will immediately notify the government Contracting Officer of any changes relating to foreign owned, controlled, or influence (FOCI) type concerns, events and/or changes which may affect the Facility Security Clearance (FCL). See Section I of the general provisions for the clause titled Notification of Government Security Activity. AF FAR Sup 5352.204-9000.

SEE ITEM 12:

Ref Block 12(1): The contractor is responsible for obtaining the approval of contracting activity prior to release of any information received or generated under this basic contract or in subsequent option periods.

Ref Block 12(2): Material (classified or unclassified) proposed for public release pertaining to this contract shall not be released for public dissemination, unless it has been approved and processed through U.S. Government appropriate channels and approved in accordance with AFI 35-102, Security and Policy Review Process; and DoD Instruction 5230.29, Security and Policy Review of DoD Information for Public Release.

(a1) HQ STARCOM/S2S; 121 S. Tejon St, Suite 1000, Colorado Springs, CO 80903 (b1) HQ STARCOM/PA; 121 S. Tejon St, Suite 1000, Colorado Springs, CO 80903 (c2) HQ STARCOM/SAPMO; 121 S. Tejon St, Suite 1000, Colorado Springs, CO 80903

Ref Block 12:(4) Contractor is to submit requests through the GCA for OPSEC Program Manager review and public release authorization. The GCA will provide the contractor with written approval/disapproval. Information requiring AF or DoD level review will be reviewed by the unit’s OPSEC Program Manager or Coordinator who will in-turn forward to the entry-level public affairs office through the AFIMSC Public Affairs Office to the Secretary of the Air Force, Office of Public Affairs, Security and Review Division (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330-1690.

Ref Block 13: The contractor will abide by all provided/attached security classification guidance including but not limited to:

Security Executive Agent Directive (SEAD) 6, Continuous Evaluation, 12 Jan 18 Security Executive Agent Directive (SEAD) 4, National Security Adjudicative Guidelines, 8 Jun 17 Security Executive Agent Directive (SEAD) 3, Reporting Requirement for Personnel with Access to Classified Information or Who Holds a Sensitive Position, 12 Jun 17 DoDM 5200.02_AFMAN 16-1405, Air Force Personnel Security Program, 1 Aug 18 DoDM 5200.01V1_DAFMAN 16-1404V1, DoD Information Security Program: Overview, Classification, and Declassification, 6 Apr 22 DoDM 5200.01V2_AFMAN16-1404V2, DoD Information Security Program: Marking of Classified Information, 7 Jan 21 DoDM 5200.01V3_DAFMAN16-1404V3, DoD Information Security Program: Protection of Classified Information, 12 Apr 22 DoDI 5200.48_DAFI16-1403, Controlled Unclassified Information (CUI), 5 Oct 21 DoDM 5220.32V1_AFMAN16-1406V2, National Industrial Security Program: Industrial Security Procedures for Government Activities, 8 May 20 32 CFR part 117, National Industrial Security Program Operating Manual DoDD 5205.16, the DoD Insider Threat Program, C2, 28 Aug 17 AFI 16-1402, Insider Threat Management, 16 Jun 20

Ref Block 14: OPSEC plan will be provided under separate cover.

Reviewing Official’s Office Symbol, phone and email (6):

SYD 81 / S3 Program Manager Reviewing Official’s Office Symbol, phone and email (6):

SYD 81 / S3 Security Manager (Acting) Reviewing Official’s Office Symbol, phone and email (6):

SSC Information Protection Office Reviewing Official’s Office Symbol, phone and email (6):

SSC/S2S/Special Security Office (SSO)

Dep Division Chief, Operations

NAME & TITLE OF REVIEWING OFFICIAL (6): DAVID STAPLETON, CIV

Chief, Det 5 Information Protection

NAME & TITLE OF REVIEWING OFFICIAL (6): TEMETRI S. HEWSTON, NH-03

SSC Information Protection

NAME & TITLE OF REVIEWING OFFICIAL (6): SHARON M. JONES, NH-03

SSC SSO OFFICE

on the installation and provide all information requested per the Notification of Government Security Activities Clause - DAFFARS 5352.204-9000, and AFMAN 16-1406, Vol 2, National Industrial Security Program: Industrial Security Procedures for Government Activities, to the SBD 1/IP, Workflow Email: SBD1.ip.wf@us.af.mil. Refer to the contract document for these clauses.

Ref Blk 11i: EMSEC requirements apply to the SCIF execution location. See DFARS 252.239-7000, DFARS 252.239-7001, Intelligence Community (IC Tech Spec‐for ICD/ICS 705), Technical Specifications for Construction and Management of Sensitive Compartmented Information Facilities, version 1.5, dated 13 March 2020; Committee on National Security Systems Advisory Memorandum (CNSSAM) TEMPEST/01-13, Red/Black Installation Guidance, dated 17 January 2014.

Any request for SCI/SCIF building, please contact the SSO office Physical Security team for forms and approval SSO.ssc.physical.security@spaceforce.mil

OPSEC plan will be provided under separate cover.

See Attachments:

Attachment 1-SCI Addendum (CUI)

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.): Defense Intelligence Agency (DIA) has exclusive security responsibility for SCI classified material released or developed under this contract and held within the contractor's SCIF. The SSO maintains inspection responsibility for all SCI material related to this contract.

Defense Counterintelligence and Security Agency (DCSA) is relieved of inspection responsibility for all classified material that is released to or developed by the contractor while on a military installation. DCSA retains inspection responsibility for all non-SCI classified material released to or developed by the contractor and held in the contractor’s facility. Space Base Delta 1 (SBD 1) Information Protection Staff is designated as a member of the SBD 1 Inspection team and has inspection authority when assigned under SBD 1/IG.

Peterson SFB, CO 80914

17. CERTIFICATION AND SIGNATURES - c. ADDRESS (Include ZIP Code): 2424 Garden of the Gods Rd.

STE F590

Colorado Springs, CO 80919