Atch 3 - DD254 C2 VTC DRAFT.pdf

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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PREVIOUS EDITION IS OBSOLETE.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)

250 Vandenberg Street, Suite B016 Peterson SFB, CO 80914-3819 CSO: Headquarters NORAD and USNORTHCOM/CSMS 250 Vandenberg Street, Suite B016 Peterson SFB, CO 80914-3819

250 Vandenberg Street, Suite B016 Peterson SFB, CO 80914-3814 Location: Cheyenne Mountain Space Force Station 1 NORAD Rd. Colorado Springs, CO 80914

HQ N&NC/J2 SSO

1. Primary support location: Headquarters (HQ) NORAD and USNORTHCOM, Bldg. 2, Peterson SFB Colorado 80914

2. The contract also requires access to the General Officer and Field Grade Officer Quarters (GO/FO) on Peterson SFB CO 80914.

3. The contract also requires access to Cheyenne Mountain Space Force Station (CMSFS), 1 NORAD Rd. Colorado Springs, CO 80914

Ref 10e(1).: All contractor SCI work and access will be at a designated SCI Facility (SCIF) at the TO level. (SEE SECTION 15 - INSPECTIONS)

Ref 10e(2).: This contract requires access to Sensitive Compartmented Information (SCI) and non-SCI intelligence information:

a. The number of personnel required to have access to SCI is determined by the COR/TM and the DoD SSO at the task order level.

b. The Director, Defense Intelligence Agency (DIA) and Director, Department of Defense (DoD) agency identified at the task order level, as the executive agent for DIA, have exclusive security responsibility for SCI released to the contractor or developed under this contract.

c. Contractor generated or Government furnished material may not be provided to the Defense Technical Information Center. Contract generated technical reports will bear the statement ‘Not Releasable to the Defense Technical Information Center per DoD Instruction 5230.24.

d. All contractor personnel requiring access to SCI information must: be U.S. citizens, have been granted a final ICD 704 security clearance by the U.S. Government, and have been indoctrinated for the applicable compartments of SCI access prior to being given any access to such information released or generated under this contract, determined at the task order level.

e. Classified material released or generated under this contract is not releasable to foreign nationals without the expressed written permission of the Director, DoD (through the DOD SSO) and Director, DIA, determined at the task order level.

f. SCI received under this contract may not be released to subcontractors.

g. The contractor and COR/TM will revalidate all SCI billets under this contract with the DoD SSO annually or when a revised DD Form 254 issued, whichever is sooner, determined at the task order level.

h. All SCI visit requests by contractors shall be forwarded to the COR/TM for approval and need-to-know certification before being sent through the DoD SSO to the facility to be visited, determined at the task order level.

Ref 10j: Controlled Unclassified Information (CUI) generated and/or provided under this contract shall be safeguarded and marked as specified in DoD Instruction 5200.48.

Ref 11a: Contractor performance is restricted to locations identified in Block 13.

Government agency or activity will provide security classification guidance for performance of this contract.

Ref 11e: Contractor is not allowed to Fabricate, Modify, or Store Classified Hardware. Perform services only.

Ref 11j : Ref 11j.: See OPSEC Addendum, to outline the requirements and procedures necessary to protect Critical Information for OPSEC.

2 Attachments:

Attachment 1 - SCI Supplement DD Form 254 Instructions FY22 Attachment 2 - DD 254 OPSEC

N&NC/J66, Primary COR rep: Ms. Abigale Roy, GG-13

N&NC/J2, SSO

250 VANDENBERG ST. STE B016

PETERSON AFB, CO 80914

Address: 21st Contracting Squadron/PKB 135 Dover St, Ste 2225 Peterson SFB, CO 80914