Atch J-3 DD Form 254.pdf

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DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of AEM LiveCycle Designer

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:

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

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

The contractor shall procure, install, un-install, transport, perform power up configuration, and provide all areas of hardware, technical personnel, software, data replication services, world-wide travel to install managed service, vendor-owned hardware and provide hardware/software upgrades, maintenance, replacement, and disposal/coordinate with Defense Reutilization and Marketing Services (DRMO) in accordance with DOD policy. Additional procurements will include the provision of switches, servers, racks, RPDU’s, UPS devices, SAN or NAS devices, and monitoring/reporting software used to support the content delivery services at all locations worldwide. This includes Navy vessels or tactical locations. The contractor shall provide full Network Operations Command Center (NOCC) capability and support for all service offerings.

All classified visit requests by contractors shall be forwarded to the Contracting Officer Representative (COR) for approval and need -to-know certification before being sent to the facility to be visited. All visit access requests (VARs) by contractors shall be sent via the Joint Personnel Adjudication System (JPAS) to the DISA VAR Center (JPAS SMO: DKABAA10) or appropriate SMO for the effort. The COR/ACOR must approve the VAR prior to sending the request to the facility being visited.

Contractors must also provide a copy of the VAR to the SM. The COR/ACOR must be notified and approve the receipt and/or generation of classified information under this contract. All classified information received and/or generated under this contract is the property of the U.S. Government regardless of proprietary claims. Upon completion or termination of this contract, the U.S. Government will be contacted for destruction or disposition instructions. Foreign Nationals will not perform on any area of the contract (classified or unclassified). Prime Contractor FSO will provide the Government a copy of the subcontractor DD Form 254 and subcontract memo for all their subcontracts meeting review criteria via a SM to submit for approval.

Period of Performance: Period of performance is a three-year base period, with three one-year renewal option periods. Total of a six year life cycle.

Reference Block 10j: Contractor will be provided with and will abide by DoDM 5400.07, DoD Freedom of Information Act Program, and DoDM 5200.01, Volume 4, DoD Information Security Program: CUI. Guidance provided under separate cover.

Reference Block 10k: SIPRNet Access is required at the Government facility. A NATO Awareness briefing is required for SIPRNet and JWICS access.

Contractor will abide by the following security classification guidance:

(NOTE: List unclassified titles or identities and provide class guide(s) either in the contract package or under separate cover. If under separate cover, add “Provided under separate cover” following the listed class guide(s).)

Reference Block 11a: Contract performance is restricted to government locations listed in block 8.a. The using contractor or Government facility will provide security classification guidance for the performance of this contract.

Reference Block 11e: Contract is to provide for Global Content Delivery Capacity Services for DISA Enterprise Services activities.

Reference Block 11f: Contractors when performing or traveling outside the United States under this contract will:

a) All personnel will obtain an AOR specific foreign travel brief within 90 days of travel and will provide proof of training to the COR/ACOR.

b) All personnel will receive the Anti-terrorism Level I Awareness training within one year prior to travel.

DECC Europe DISA DECC Wiesbaden , Flugplatz Erbenheim , Geb. 1000, Rm. T3 , Wiesbaden GE 65205 39 Camp Arifjan, Kuwait - Camp Arifjan Kuwait Apo, AE 09366.

41 Bagram AB, Bagram, Afghanistan - AE 09354 38 TECC NSA Bahrain - PSC 451 Box 200, Kingdom Of Bahrain 46 Al Udeid AB, Doha, Qatar, 379/ECS/SCPF/GDIT AL UDEID AB, DOHA, QATAR 09309 38 Al Dhafra AB, Abu Dhabi, UAE, 380 ECS SCOIT Al Dhafra AB APO AE, 09853 41 Camp Lemonier, DJI - PSC 831 Box 0040 FPO AE 09363-0001 44 Korea - Yongsan Army Garrison, Korea - PSC 479 FPO AP 96269-1100 46 Kadena AFB, Okinawa, JPN - PSC 480 Box 1100 FPO AP Okinawa, Japan 96370-1100 56 NCTS Naval Base, Finegayan, GUM - PSC 445 Box 152 FPO AP, Guam 96540-1000 58 Yokota AFB, JPN - Japan, 〒197-8503 Tokyo, Fussa, 大字福生2552 108 NSA Naples, ITA - PSC 817 Box 1 FPO AE Naples, Italy 09622-0001

Reference Block 11m: IT-I access required, billets required is 3.

DISA Instruction 240-110-43, Insider Threat Program' and 'DoD Manual 5200.02, Procedures for the DoD Personnel Security Program, 3 April 2017

GCDS II Locations

CONUS

DECC Montgomery, Gunter Annex AFB, 401 East Moore Drive, Maxwell AFB/Gunter Annex, Montgomery, Alabama 36114-3001 Fort Wainwright, Fairbanks - 507th Signal Company, Bldg 1060, Gaffney Road, Fort Wainwright, Alaska 99703 North Island - Naval Base Coronado, San Diego, California 92135 Buckley AFB - 18500 E 6th Ave, Aurora, Colorado 80011 Pensacola NAS, Pensacola - 45 Industrial Blvd, Suite C, Pensacola, Florida 32503 Fort Meade, Md - 6906 Cooper Avenue, Fort Meade, Maryland 20755 DECC St Louis - 4300 Goodfellow Blvd., St. Louis, Missouri 63120-0012 Offutt Air Force Base - 510 Custer Drive, Offutt AFB, Nebraska 68113-0000 DECC Columbus - Defense Distribution Deport Columbus, 3990 East Broad St., Bldg. 23, Columbus, Ohio 43213 Wright-Patterson AFB - 5135 Pearson Road, Building 10. Wright-Patterson AFB, Ohio 45433 DECC Oklahoma City - 8705 Industrial Blvd., Tinker AFB, Oklahoma City, Oklahoma 73145-3064 DECC Mechanicsburg - Naval Supply Depot, 5450 Carlisle Pike, Mechanicsburg, Pennsylvania 17050-0975 DECC San Antonio - Kelly AFB, Kelly Field Annex, Texas 78243 DECC Ogden - Defense Depot Hill Utah, 7879 Wardleigh Road, Bldg. 891, Hill AFB, Utah 84056-5996 Fort Belvoir - Bldg. 2118, Abbot Road, Fort Belvoir, Virginia, 22060 Norfolk Naval Base - 1530 Gilbert St #2000, Norfolk, Virginia 23511 Pentagon, VA - 7010 Defense Pentagon Washington, DC 20301-7010

2300 EAST DRIVE SCOTT AFB, IL 62225-5406

Address: 1 OVERCASH AVE, BLDG 12

CHAMBERSBURG, PA 17201