Attach 14 - PCTE DD254.pdf
PDF 65 KB Posted
- Attached to
- Cyber TRIDENT Federal contract opportunity
- Solicitation number
- W900KK-20-R-0001
About this file
This document is a DD Form 254, which specifies security requirements and classification guidance for a Department of Defense contract. The contractor will require access to classified information up to the Secret level and will perform work involving both classified and unclassified information. Access to Sensitive Compartmented Information is authorized for U.S. citizens only. The contracting activity is the U.S. Army Contracting Command Orlando Contracting Center. The contract number is W900KK-20-R-0001 and seeks to provide cyber training, readiness, integration, delivery, and enterprise technology services in support of the Army's Program Executive Office for Simulation, Training and Instrumentation.
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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PREVIOUS EDITION IS OBSOLETE.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)
| CurrentPage: |
| PageCount: |
| Classification: Official |
| SerialNum: |
| a. Facility clearance level. Select one.: 1 |
| b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 1 |
| Choose Yes or No: 0 |
| Choose Yes or No: 0 |
| Prime: |
| Choose Yes or No: 0 |
| Choose Yes or No: 0 |
| Sub: |
| Choose Yes or No: 1 |
| Choose Yes or No: 0 |
| Soli: |
| DueDate: |
| dateA: |
| RevisionNum: |
| dateB: |
| Final: |
| dateC: |
| No: 1 |
| No: 1 |
| No: 0 |
| No: 0 |
| Yes: 0 |
| Yes: 0 |
| Yes: 1 |
| Yes: 1 |
| Enter your name here.: |
| ReqDated: |
| Enter your name here.: |
| Name: PLANNING PURPOSES ONLY |
| Name: Slupski, Stanley M. |
| Cage: |
| CSO: |
| addrow: |
| Removerow: |
| Click to delete a row: |
| Location: See item 13 attachment |
| Block9: |
| a: 0 |
| a: 0 |
| a: 1 |
| f: 0 |
| f: 0 |
| f: 0 |
| b: 0 |
| b: 0 |
| b: 0 |
| g: 0 |
| g: 0 |
| c: 0 |
| c: 1 |
| c: 1 |
| h: 0 |
| h: 0 |
| d: 0 |
| d: 0 |
| d: 1 |
| i: 0 |
| i: 0 |
| SCI: 1 |
| NonSCI: 1 |
| j: 1 |
| j: 1 |
| k: 1 |
| k: 1 |
| Enter your name here.: Access to SIPRnet, JWICS and possibly NSANet |
| Enter your name here.: Item 11M Only U.S. Citizens are authorized to work on this contract. See dual citizen restrictions |
| e: 0 |
| e: 1 |
| l: 1 |
| m: 1 |
| direct: 0 |
| thru: 1 |
| Enter your name here.: ACC Orlando, 12211 Science Dr Orlando, FL 32826 |
| PublicAuthority: PM ITTS, CM, OPSEC Off, 12211 Science Dr Orlando, FL |
PEO STRI PAO, 12211 Science Dr Orlando, FL 32826
| AddSig: |
| RemoveSig: |
| text: "The undersigned has reviewed this Security Specification and understands the provisions herein. The undersigned will ensure compliance with the provisions within the limits of his/her responsibility. Furthermore the undersigned will report any security incidents to the supporting Security Manager, ISS and KO". |
| attachmentsList: |
| AddAttachment: |
| ViewAttachment: |
| RemoveAttachment: |
| rep: James Kozlowski, COR |
| Sig: |
| Enter your name here.: See block 13 Security Guidance, SCI addendum, NSAnet docs and FOUO Addendum's attached as the DD254 package. |
| Enter your name here.: The Government Project Manager’s/Director’s working in conjunction with the Contracting Officer of this effort will coordinate with the cognizant security office for ensuring contractor compliance with the security terms of the DD 254 blocks 10,11,12,13 and addendum sheets. The government PM/PD’s will monitor and verify the contractor’s security responsibilities during the life of the contract and the PEO STRI Industrial Security Specialist will coordinate with the KO, COR and contract Specialist when conducting site security inspections of the contractor facility in accordance with AR 380-49, Army Industrial Security. |
| GCAName: ACC Orlando |
| AAC: W900KK |
| AAC: W900KK |
| Address: ACC Orlando |
12211 Science Dr Orlando, FL 32826 Address: PEO STRI G2 12211 Science Dr Orlando, FL 32816
| POCName: Rebeca Gonzalez |
| Phone: 4073843968 |
| Phone: 4073843540 |
| Email: rebeca.a.gonzalez.civ@mail.mil |
| Email: stanley.m.slupski.civ@mail.mil |
| Title: Industrial Security Specialist |
| Enter the date using the format DD-Mon-YYYY: |
File details come from the government source that posted it. Updated .