Attach 0005 DD254_SAMA 3.0 v1.pdf
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- Solicitation number
- W519TC-26-R-A024
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PREVIOUS EDITION IS OBSOLETE.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" Show Attachment Bar
| CurrentPage: |
| PageCount: |
| Classification (when form is filled in) (automatically filled from previous drop-down list): Unclassified |
| Serial Number: |
| 1. CLEARANCE AND SAFEGUARDING - a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED |
(See Instructions) - Select from drop-down list: 2
| 1. CLEARANCE AND SAFEGUARDING - b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/MATERIAL REQUIRED AT CONTRACTOR FACILITY - select from drop-down list: 4 |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - Select for "a. PRIME CONTRACT NUMBER": 0 |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - a. PRIME CONTRACT NUMBER (See instructions.): |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - Select for "b. SUBCONTRACT NUMBER": 0 |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - b. SUBCONTRACT NUMBER: |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - Select for "c. SOLICITATION OR OTHER NUMBER": 1 |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER: W519TC-26-R-A024 |
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER - DUE DATE (YYYYMMDD): 20260415 |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "a. ORIGINAL (Complete date in all cases.) ": 1 |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - a. ORIGINAL (Complete date in all cases.) : |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "b. REVISED (Supersedes all previous specifications.)": 0 |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - REVISION NUMBER: |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - DATE (YYYYMMDD): |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "c. FINAL (Complete Item 5 in all cases.)": 0 |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.): |
| 3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.) - DATE (YYYYMMDD): |
| 4. IS THIS A FOLLOW-ON CONTRACT? - Select for "no.": 0 |
| 4. IS THIS A FOLLOW-ON CONTRACT? - Select for "yes.": 1 |
| 4. IS THIS A FOLLOW-ON CONTRACT? - If yes - Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract. - Enter preceding contract number.: W52P1J-21-C-0026 |
| 5. IS THIS A FINAL DD FORM 254? - Select for "no.": 1 |
| 5. IS THIS A FINAL DD FORM 254? - Select for "yes.": 0 |
| 5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of (period) - Enter contractor's request date in format YYYYMMDD.: |
| E5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of - Enter period.: |
| 6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code) - a. NAME, ADDRESS, AND ZIP CODE: |
| 6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code) - b. CAGE CODE: |
| 6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code) - c. COGNIZANT SECURITY OFFICE(S) (CSO) |
(Name, Address, ZIP Code, Telephone required; Email Address optional):
| 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) - Select to add row: |
| 7. SUBCONTRACTOR(S) - Select to remove last row: |
| 7. SUBCONTRACTOR(S) - Select to delete all rows: |
| 7. SUBCONTRACTOR(S) - a. NAME, ADDRESS, AND ZIP CODE: |
| 7. SUBCONTRACTOR(S) - b. CAGE CODE: |
| 7. SUBCONTRACTOR(S) - c. COGNIZANT SECURITY OFFICE(S) (CSO) |
(Name, Address, ZIP Code, Telephone required; Email Address optional):
| 8. ACTUAL PERFORMANCE (Click button to add more locations.) - Select to add row : |
| 8. ACTUAL PERFORMANCE - Select to remove last row: |
| 8. ACTUAL PERFORMANCE - Select to delete all rows : |
| 8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): Primarily on the Baghdad Embassy Compound (BEC) and |
various locations in Iraq for performance of duties and responsibilities to support the SAMA mission for USMILGP-Iraq.
| 8. ACTUAL PERFORMANCE - b. CAGE CODE (If applicable, see Instructions.): |
| 8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): |
| Enter general unclassified description of this procurement.: Security Assistance Mentors and Cultural Advisors (SAMA) services will be provided to assist the military and civilian personnel engaged in |
mentoring and assisting the Iraq Ministry of Defense (MoD), the Ministry of Peshmerga Affairs (MoPA), and the Counter Terrorism Service (CTS) to design, implement, and sustain systems that increase their institutional capabilities.
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION.": 0 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "b. RESTRICTED DATA.": 0 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.).": 0 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "d. FORMERLY RESTRICTED DATA.": 0 |
| 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: Select for "(1) Sensitive Compartmented Information (SCI).": 0 |
| 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: Select for "(2) Non-SCI.": 1 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION.": 0 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "g. NORTH ATLANTIC TREATY ORGANIZATION (NATO) INFORMATION.": 1 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "h. FOREIGN GOVERNMENT INFORMATION.": 1 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "i. ALTERNATIVE COMPENSATORY CONTROL MEASURES (ACCM) INFORMATION.": 0 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "j. CONTROLLED UNCLASSIFIED INFORMATION (CUI).": 1 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "k. OTHER .": 0 |
| 10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - k. OTHER (Specify) (See instructions.): |
| 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.) - Select for "a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT ANOTHER CONTRACTOR'S FACILITY OR A GOVERNMENT ACTIVITY." (Applicable only if there is no access or storage required at contractor facility. See instructions.): 1 |
| 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.) - Select for "b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY.": 0 |
| 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.) - Select for "c. RECEIVE, STORE, AND GENERATE CLASSIFIED INFORMATION OR MATERIAL.": 1 |
| 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.) - Select for "d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE.": 0 |
| 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.) - Select for "e. PERFORM SERVICES ONLY.": 1 |
| 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.) - Select for "f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE THE U.S.,PUERTO RICO, U.S. POSSESSIONS AND TRUST ERRITORIES.": 1 |
| 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.) - Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 1 |
| 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.) - Select for "h. REQUIRE A COMSEC ACCOUNT.": 0 |
| 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.) - Select for "i. HAVE A TEMPEST REQUIREMENT.": 0 |
| 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.) - Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1 |
| 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.) - Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0 |
| 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.) - Select for "l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI)." (DoD Components: refer to DoDI 5200.48, only for specific CUI protection requirements. Non-DoD Components: see instructions.): 1 |
| 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.) - Select for "m. OTHER.": 0 |
| 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.) - m. OTHER (Specify) (See 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) - Select for "DIRECT": 0 |
| 12. PUBLIC RELEASE - Select for "THROUGH": 1 |
| 12. PUBLIC RELEASE - Enter specification for "through".: |
| 12. PUBLIC RELEASE - Public Release Authority:: Procuring Contracting Officer |
| 13. SECURITY GUIDANCE - Select to add signature row: |
| 13. SECURITY GUIDANCE - Select to remove last signature row: |
| 13. SECURITY GUIDANCE - Select to delete all signature rows: |
| 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.): A. DoD Regulations and policies for generating, handling, storing, and destroying classified material.
B. DoS Regulations and policies for generating, handling, storing, and destroying classified material.
C. All applicable Security Classification Guides, including but not limited to, the CENTCOM Classification Guide.
D. Any classified information generated in the performance of this contract shall be classified according to the markings shown on the source materials. Detailed security classification guidance will be provided upon arrival in theater. Classification markings on the material to be furnished will provide the classification guidance necessary for the performance of the contract.
E. This contract involves access to information classified "Sensitive But Unclassified", "For Official Use Only", "Confidential", and/or "Secret".
All contractor personnel to be granted access to classified information released or generated under this contract must have the appropriate clearance or interim clearance for the level of access required. In addition, access to classified material will be limited to those personnel having not only an appropriate clearance, but a valid need to know. Access to SIPR/CLASSNet and/or NIPR/OPENet is required for performance of this contract. The contractor shall appropriately safeguard SBU and FOUO information from public disclosure and shall use the material only for contract performance.
| List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form) - Click on this button to attach a file(s).: |
| Reviewing Official’s Office Symbol, phone and email (1): |
| NAME & TITLE OF REVIEWING OFFICIAL (1): |
| 17. CERTIFICATION AND SIGNATURES - h. SIGNATURE : |
| Reviewing Official’s Office Symbol, phone and email (2): |
| NAME & TITLE OF REVIEWING OFFICIAL (2): |
| SIGNATURE (2): |
| Reviewing Official’s Office Symbol, phone and email (3): |
| NAME & TITLE OF REVIEWING OFFICIAL (3): |
| SIGNATURE (3): |
| Reviewing Official’s Office Symbol, phone and email (4): |
| NAME & TITLE OF REVIEWING OFFICIAL (4): |
| SIGNATURE (4): |
| Reviewing Official’s Office Symbol, phone and email (5): |
| NAME & TITLE OF REVIEWING OFFICIAL (5): |
| SIGNATURE (5): |
| Reviewing Official’s Office Symbol, phone and email (6): |
| NAME & TITLE OF REVIEWING OFFICIAL (6): |
| SIGNATURE (6): |
| 14. ADDITIONAL SECURITY REQUIREMENTS - Requirements, in addition to NISPOM requirements for classified information, are established for this contract. - Select for "no.": 1 |
| 14. ADDITIONAL SECURITY REQUIREMENTS - Requirements, in addition to NISPOM requirements for classified information, are established for this contract. - Select for "yes.": 0 |
| 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. - Select for "no.": 1 |
| 15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0 |
| 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) - a. GCA NAME: Army Contracting Command - Rock Island |
| 16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions): W519TC |
| 16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - c. ADDRESS (Include ZIP Code): 3055 Rodman Avenue |
Bldg. 60 Rock Island, IL 61299-8000
| 16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - d. POC NAME: David Fields |
| 16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - e. POC TELEPHONE (Include Area Code): 5715888562 |
| 16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - f. EMAIL ADDRESS (See Instructions): david.s.fields16.civ@mail.mil |
| 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): BUSONICK, BERNARD J. |
| 17. CERTIFICATION AND SIGNATURES - b. TITLE : SECURITY MANAGER/OSC-I |
| 17. CERTIFICATION AND SIGNATURES - c. ADDRESS (Include ZIP Code): BAGHDAD EMBASSY |
| 17. CERTIFICATION AND SIGNATURES - d. AAC OF THE CONTRACTING OFFICE (See Instructions): |
| 17. CERTIFICATION AND SIGNATURES - e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.): |
| 17. CERTIFICATION AND SIGNATURES - f. TELEPHONE (Include Area Code): 945603038 |
| 17. CERTIFICATION AND SIGNATURES - g. EMAIL ADDRESS (See Instructions): busonickbj@state.gov |
| 17. CERTIFICATION AND SIGNATURES - i. DATE SIGNED (See Instructions): |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "b. SUBCONTRACTOR.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 1 |
| 18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Enter specification for "other." (If more room is needed, continue in Item 13 or on additional page if necessary.): Certifying Official will distribute to Procuring Contracting |
Officer (PCO) and Contract Specialist at Army Contracting Command - Rock Island. The PCO and Contract Specialist will then distribute accordingly.
File details come from the government source that posted it. Updated .