Att 8 - DD Form 254.pdf
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- Solicitation number
- FA865023S5012
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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PREVIOUS EDITION IS OBSOLETE.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:
June 30, 2025 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 |
| Enter serial number.: 22-S-5012 |
| a. Facility clearance level. Select one.: 1 |
| b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 2 |
| Select for "original.": 0 |
| Select for "original.": 1 |
| Enter prime contract number.: |
| Select for "revised.": 0 |
| Select for "revised.": 0 |
| Enter subcontract number.: |
| Select for "final.": 1 |
| Select for "final.": 0 |
| Enter solicitation or other number.: FA8650-22-S-5012 |
| Enter due date in format YYYYMMDD.: |
| Enter date in format YYYYMMDD.: 20220915 |
| Enter revision number.: |
| Enter date in format YYYYMMDD.: |
| Enter final specification.: |
| Enter date in format YYYYMMDD.: |
| Select for "no.": 0 |
| Select for "no.": 1 |
| Select for "no.": 1 |
| Select for "no.": 0 |
| Select for "yes.": 1 |
| Select for "yes.": 0 |
| Select for "yes.": 0 |
| Select for "yes.": 1 |
| Enter preceding contract number.: FA8650-16-D-5408 |
| Enter contractor's request date in format YYYYMMDD.: |
| Enter period.: |
| Enter typed name of certifying official (last, first, middle initial).: TBD |
| Enter typed name of certifying official (last, first, middle initial).: N/A |
| Enter typed name of certifying official (last, first, middle initial).: Merrifield, Mark L. |
| Enter CAGE code of the prime contractor.: TBD |
| Enter CAGE code of the prime contractor.: N/A |
| Enter CAGE code of the prime contractor.: N/A |
| Enter CAGE code of the prime contractor.: TBD |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: TBD |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: N/A |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: See Block 15 |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: TBD |
| Select to add row to locations.: |
| Select to remove last row from locations.: |
| Select to delete all signatures.: |
| Enter location(s).: AFRL/RX |
650 Complex 3005 Hobson Way, Area B Wright-Patterson AFB, OH 45433
| Enter location(s).: Additional work locations to be determined upon contract award. |
| Enter general unclassified description of this procurement.: Materials for Integrated Nano-electronic and Optoelectronic Structures (MINOS) is an on-site ID/IQ contract. The objectives are to execute research and development which exploit competencies that enhance electronic, optoelectronic, photonic, and quantum materials, and as well as hybrid systems to enable next-generation effective and novel ISR and EW systems for DAF applications. Tasks include Program Management; Electronic Materials Research, Development, and Prototyping; Photonic, Optoelectronic and Quantum Materials Research, Development, and Prototyping; Emergent Opportunities in Electronics, Optics and Photonics; Modeling and Theory; Material Synthesis/Growth; Fabrication/Processing; Characterization/Testing; Research Community Leverage and Interaction; and Acquisition of Special Test Equipment / Contractor Acquired Property. |
| Select for "a. CONTRACTOR.": 0 |
| Select for "a. CONTRACTOR.": 0 |
| Select for "a. CONTRACTOR.": 1 |
| Select for "f. OTHER AS NECESSARY.": 0 |
| Select for "f. OTHER AS NECESSARY.": 0 |
| Select for "f. OTHER AS NECESSARY.": 1 |
| Select for "b. SUBCONTRACTOR.": 0 |
| Select for "b. SUBCONTRACTOR.": 1 |
| 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.": 1 |
| 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.": 1 |
| 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.": 0 |
| 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).": 1 |
| Select for "e. NATIONAL INTELLIGENCE INFORMATION: - (2) Non-SCI.": 1 |
| 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.": 1 |
| Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0 |
| Enter infomration for "other.": Program Protection Plan (PPP) |
| Enter infomration for "other.": Comply with AFFARS 5352.204-9000, See Block 13 |
| Enter infomration for "other.": AFRL/RX OSF, 2977 Hobson Way, Wright-Patterson AFB, OH 45433, afrl.rx.security@us.af.mil. |
| 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.": 1 |
| Select for "direct.": 0 |
| Select for ": 1 |
| Enter specification for "through".: Public release of classified or Controlled Unclassified Information (CUI) is NOT authorized. |
| Enter public release authority.: See Block 13 |
| Select to add signature.: |
| Select to remove last signature.: |
| text: A. Authoritative Guidance and References: |
1. 32 Code of Federal Regulations, Part 117, National Industrial Security Program Operating Manual (NISPOM), 24 February 2021, applies
2. DoDM 5200.01, Volume 1, DoD Information Security Program: Overview, Classification and Declassification, 24 February 2012, Change 2, 28 July 2020
3. DoDM 5200.01, Volume 2, DoD Information Security Program: Marking of Information, 24 February 2012, Change 4, 28 July
4. DoDM 5200.01, Volume 3, DoD Information Security Program: Protection of Classified Information, 24 February 2012, Change 3, 28 July 2020
5. DoDI 5200.02, DoD Personnel Security Program (PSP), 21 March 2014, Change 3, 24 September 2020
6. DoDM 5200.02 (03 April 2017)_AFMAN 16-1405 (01 August 2018)_AFGM 2022-01 (08 February 2022), Procedures for the DoD Personnel Security Program (PSP), Air Force Manual and Air Force Guidance Memo
7. DoDI 5200.48, Controlled Unclassified Information, 06 March 2020; and OSD Memo for Clarifying Guidance for Marking and Handling Controlled Technical Information, 2021
8. DoDI 8510.01 Risk Management Framework (RMF) for DoD Information Technology (IT), 12 March 2014, Change 3, 29 December 2020
9. Defense Federal Acquisition Regulation Supplement (DFARS) 252.204-7012, 28 June 2019
10. DoDM 5400.07_AFMAN 33-302, DoD Freedom of Information Act (FOIA) Program, 21 April 2018
11. DoD Issuances website: http://www.esd.whs.mil/dd/
12. AF e-Publications website: https://www.e-publishing.af.mil/
CONTINUATION - BLOCKS 10 & 11:
B. Ref Item 10.e.(1) Upon selection of contract award, the PM has determined the Contractor will require access to Sensitive Compartmented Information (SCI) materials. SCI security requirements will apply; upon award a new DD-254 will be issued along with an SCI addendum from the 21 IS/INS, WPAFB SSO to depict SCI security and inspection requirements.
C. Ref Item 10.e.(2) Contractor will require access to intelligence information and must comply with directions provided by the Contracting Monitor (CM). The CM has determined that disclosure does not create an unfair competitive advantage for the Contractor or a conflict of interest with the Contractor’s obligation to protect the information. The CM will identify what intelligence information is required for the Contractor to satisfy the contract and will submit that information to the AFRL servicing Senior Intelligence Officer (SIO) at AFRL/XP2 for approval prior to granting access.
D. Ref Items 10.j. & 11.1: The Contractor shall comply with DoDI 5200.48, Controlled Unclassified Information; AFMAN 16-1404, Volume 1, Operations Support, Information Security Program: Overview, Classification, and Declassification; Air Force Guidance Memorandum 2020-16-01, Air Force Guidance Memorandum for CUI, 23 July 2020; and DoDM 5400.7-Air Force Manual 33 302, 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.
E. Ref Item 10.k: A Program Protection Plan (PPP) will be provided by the Government activity if required.
F. Ref Item 11.c:
1. Upon award, the Prime contractor will be authorized to receive, store, and generate SECRET Collateral information or material.
2. Contractor will reference the appropriate security classification guidance when generating or deriving classified material or hardware. All classified information received or generated will be properly stored and handled according to the markings on the material. All classified information received or generated is the property of the U.S. Government. At the termination or expiration of the contract, the U.S. Government will be contacted to proper disposition instructions.
3. Upon issuance of a subcontract(s) by the Prime Contractor, the Subcontractor(s) may also be authorized to receive, store, and generate SECRET Collateral information or material. Any flow down classified access will require generation of a new subcontract DD Form 254, routed through the Government Program Office (AFRL/RX; contact information below). This DD Form 254 does NOT grant any access to any Subcontractor inherently.
G. Ref Item 11.d: The contractor will be required to provide adequate and approved storage for classified hardware or material to the level of SECRET which because of size or quantity cannot be safeguarded in an approved storage container.
H. Ref Item 11.g: The contractor is authorized the use of the Defense Technical Information Center (DTIC); however, classified information and intelligence data are not releasable to DTIC. No contract information is releasable to DTIC and/or any other organization/program/project. The Government Program Office (GPO) has sole distribution authority.
I. Ref Item 11.j: Operations Security (OPSEC) requirements apply; see Statement of Objectives (SOO) for requirements.
J. Ref Item 11.m: Upon award, the contractor will be required to provide the information requested by the Notification of Government Security Activity and Visitor Group Agreements clause, Air Force Federal Acquisition Regulation Supplement (AFFARS) Industrial Security Procedures for Government Activities, 08 May 2020, by following security procedures of the installation IAW para 3.8.a.; reporting adverse information IAW para 4.14; and supporting commander self-inspections and self-assessments IAW para 14.1.f.
CONTINUATION - BLOCK 12:
K. Ref Item 12: Public Release of classified information, SCI, and CUI is NOT authorized. The Contractor is to submit requests through the Contracting Officer for OPSEC Program Manager review and public release authorization. The Contracting Officer 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 it 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, D.C. 20330-1690. MAJCOM/DRUs will send information requiring AF- or DoD-level review directly to SAF/PAX. Transmission of public release requests via e-mail is not authorized.
L. AFRL/RX CONTACT INFORMATION:
1. Government Program Manager: Joseph G. Burns, Program Manager, (937) 255-9594 , joseph.burns.9@us.af.mil
2. AFRL/RX Industrial Security: Journey L. Morgan, Organization Senior Functional, (937) 255-5559, journey.morgan.3@us.af.mil
| text: Program Manager |
| text: Organization Senior Functional |
| Click on this button to attach a file(s).: |
| rep: Joseph G. Burns |
AFRL/RXAN
rep: Journey L. Morgan
AFRL/RXOS
| Enter signature.: |
| Explain and identify specific areas and government activity responsible for inspections.: A. Ref Item 10.e(1): 21 IS/INS, SSO WPAFB, (937) 255-0431, has exclusive security responsibility for SCI classified material released or |
developed under this contract. SCI security requirements will apply; an SCI addendum with details will be provided upon contract award.
B. Ref Item 11.m: Partial contractor performance will occur at AFRL/RX on Wright-Patterson AFB, OH. DCSA is relieved of all inspection responsibilities for Contractor performance on the installation. AFRL/RXOS, Wright-Patterson AFB, OH 45433-7629, will maintain security and inspection oversight for collaterally classified information on the installation. The Servicing SSO has inspection oversight for SCI materials.
| Enter GCA name.: TBD |
| Enter AAC of the contracting office.: TBD |
| Enter AAC of the contracting office.: FA8650 |
| Enter address (include zip code).: TBD |
| Enter address (include zip code).: AFRL/RXKM |
2130 Eighth St., Bldg. 45, Area B Wright-Patterson AFB, OH 45433-7801
| Enter POC name.: TBD |
| Enter telephone number (include area code).: 9377139880 |
| Enter email address.: mark.merrifield@us.af.mil |
| Enter title.: Contracting Officer |
| Enter the datesigned in format YYYYMMDD.: 20220919 |
File details come from the government source that posted it. Updated .