Attachment 0001 Draft DD254 and Addendum.pdf

UNCLASSIFIED

DEPARTMENT OF DEFENSE OMB No. 0704-0567 OBM approval expires Jun 30, 2025

CONTRACT SECURITY CLASSIFICATION SPECIFICATION

(The requirements of the National Industrial Security Program (NISP) apply to all security aspects of this effort involving classified information.)

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 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 I des not display a currently valid OMB number.

RETURN COMPLETED FORM AS DIRECTED IN THE INSTRUCTIONS.

1. CLEARANCE AND SAFEGUARDING

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED (See Instructions)

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION / MATERIAL

REQUIRED AT CONTRACTOR FACILITY

TOP SECRET TopSecret

2. THIS SPECIFICATION IS FOR: (X and complete as applicable) 3. THIS SPECIFICATION IS: (X and complete as applicable)

a. PRIME CONTRACT NUMBER (See instructions.)

a. ORIGINAL (Complete date in all cases)

DATE (YYYYMMDD)

b. SUBCONTRACT NUMBER

b. REVISED (Supersedes all previous specifications.)

REVISION NO.

c. SOLICITATION OR OTHER NUMBER

DUE DATE

(YYYYMMDD)

c. FINAL (Complete Item 5 in all cases)

4. IS THIS A FOLLOW-ON CONTRACT? No Yes If Yes, complete the following:

Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract.

� 5. IS THIS A FINAL DD FORM 254? No Yes If Yes, complete the following:

In response to the contractor's request dated , retention of the identified classified material is authorized for the period of:

6. PRIME CONTRACTOR (Include Commercial and Government Entity (CAGE) Code.)

a. NAME, ADDRESS, AND ZIP CODE

b. CAGE CODE

c. COGNIZANT SECURITY OFFICE (CSO)

(Name, Address, ZIP Code, Telephone; Email Address optional)

7. SUBCONTRACTOR (None.)

8. ACTUAL PERFORMANCE

a. LOCATION(S)

b. CAGE CODE

c. COGNIZANT SECURITY OFFICE (CSO)

(Name, Address, ZIP Code, Telephone; Email Address optional)

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Provides world-wide operational logistics and facility engineering services to INSCOM Major Subordinate Commands (MSCs) and Programs, U. S. Forces- Afghanistan (USFOR-A), National Security Agency (NSA), National Geospatial Intelligence Agency (NGA), U. S. Central Command (CENTCOM), U. S.

Southern Command (SOUTHCOM), Defense Intelligence Agency (DIA), U. S. Forces Korea, and other agencies.

DD Form 254, APR 2018 PREVIOUS EDITION IS OBSOLETE

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION

f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

b. RESTRICTED DATA �

g. NORTH ATLANTIC TREATY ORGANIZATION (NATO)

INFORMATION

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.)

h. FOREIGN GOVERNMENT INFORMATION

d. FORMERLY RESTRICTED DATA

i. ALTERNATIVE COMPENSATORY CONTROL

MEASURES (ACCM) INFORMATION

e. NATIONAL INTELLIGENCE INFORMATION: �

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI)

X

(1) Sensitive Compartmental Information (SCI) �

k. OTHER (Specify)

(2) Non-SCI

11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL:

a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT

ANOTHER CONTRACTOR’S FACILITY OR A GOVERNMENT

ACTIVITY

g. BE AUTHORIZED TO USE THE SERVICES OF

DEFENSE TECHNICAL INFORMATION CENTER (DTIC)

OR OTHER SECONDARY DISTRIBUTION CENTER

h. REQUIRE A COMSEC ACCOUNT

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY �

i. HAVE A TEMPEST REQUIREMENT

c. RECEIVE, STORE, AND GENERATE CLASSIFIED INFORMATION

OR MATERIAL

j. HAVE OPERATIONS SECURITY (OPSEC)

REQUIREMENTS

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE �

k. BE AUTHORIZED TO USE THE DEFENSE COURIER

SERVICE

e. PERFORM SERVICES ONLY

l. RECEIVE, STORE, OR GENERATE CONTROLLED

UNCLASSIFIED INFORMATION (CUI).

f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE

THE U.S., PUERTO RICO, U.S. POSSESSIONS AND TRUST

TERRITORIES

m. OTHER (Specify)

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 (INSPOM) or unless it has been approved for public release by appropriate U.S. Government authority. Proposed public release 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)

DIRECT �

THROUGH (Specify below) PUBLIC RELEASE AUTHORITY:

� PUBLIC RELEASE OF SCI IS NOT AUTHORIZED

PUBLIC RELEASE OF SCI IS NOT AUTHORIZED

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 classification assigned or recommended.

(Fill in as appropriate for the classified effort. Attach, or forward under separate correspondence, any document/guides/extracts referenced herein. Add additional pages as needed to provide complete guidance.)

SEE SECTION 13 CONTINUATION SECTION AT THE BOTTOM OF THIS FORM

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

NAME & TITTLE OF REVIEWING OFFICIAL

SIGNATURE

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, are established for this contract.

No �

Yes 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 cognizant security office (CSO).

See SCI addendum / Contractors may or may not be hand receipt holders. Within the Army, COMSEC customdians are either DA civilians or military members. Contractors are considered hand receipt holders. See AR 380-40 for further guidance on COMSEC.

15. INSPECTIONS.

Elements of this contract are outside the inspection responsibility of the cognizant security office (CSO).

No �

Yes If Yes, explain and identify specific areas and government activity responsible for inspections.

SCI addendum / HQDA, G2

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)

a. GCA NAME d. POC NAME

Army Contracting Command-Inscom (ACC-INSCOM)

b. AAC OF CONTRACTING OFFICE e. POC TELEPHONE

c. ADDRESS f. EMAIL ADDRESS

8825 BEULAH STREET, FT BELVOIR, VA, 22060-5246

17. CERTIFICATION AND SIGNATURE

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)

d. AAC OF CONTRACTING OFFICE

h. SIGNATURE

b. TITLE e. CAGE CODE OF THE PRIME CONTRACTOR

Industrial Security Specialist

c. ADDRESS (Include ZIP Code) f. TELEPHONE (Include Area Code.) I. DATE SIGNED

8825 BEULAH STREET, FT BELVOIR, VA, 22060-5246

g. EMAIL ADDRESS

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

a. CONTRACTOR � f. OTHERS AS NECESSARY (If more room is needed, continue on Item 13 or on additional page if necessary.)�

b. SUBCONTRACTOR �

c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR

d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY

ADMINISTRATION

e. ADMINISTRATIVE

Section 13 Continuation: SECURITY GUIDANCE. The security classification guidance 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 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 document/guides/extracts referenced herein. Add additional pages as needed to provide complete guidance.

10a: Classified COMSEC material is not releasable to contractor employees who have not received a FINAL clearance at the appropriate security level.

COMSEC access shall be IAW DoD 5220.22-M and AR 380-40. When access is required at Government facilities, contractor personnel will adhere to COMSEC rules and regulations as mandated by Command policy and procedures. Written concurrence of the CM is required prior to subcontracting.

10e1: SCI Access required. No public release of information authorized, public disclosure or confirmation of any subject related to the support contract is not authorized without first obtaining written approval from the CM.

10e2: Non-SCI Information is not releasable to contractor employees who have not received a clearance at the appropriate security level. Written concurrence of the CM is required prior to subcontracting. Access to Intelligence information required for performance.

10g: Personnel not assigned to a NATO staff position, but requiring access to NATO classified information, NATO COSMIC, NATO Secret or access to the NATO accredited SIPRNET terminals, must possess the equivalent FINAL or Interim U.S. Security Clearance based upon the appropriate personnel security investigation required. Personnel with access to NATO ATOMAL information must have the appropriate level FINAL U.S. Security Clearance. The government program/project manager is the designated representative that will ensure the contractor security manager and concerned employees are NATO briefed prior to access being granted. The contractor will maintain strict compliance in regards to NATO information IAW NISPOM Ch 10, Section 7.

Prior approval from the CM is required for subcontracting.

10h: Foreign Government Information (FGI) is not releasable to contractor employees who have not received a FINAL clearance at the appropriate security level. Written concurrence of the CM is required prior to subcontracting.

10j: For Official Use Only (FOUO) Information generated and/or provided under this contract shall be safeguarded and marked as specified in DoD 5200.1-R.

10k: IF PROVIDED THIS TEXT SHOULD PROVIDE A COMPLETE DESCRIPTION FOR (OTHER) Additional notes: AKO, COP, NIPRNET, SIPRNET, JWICS, NSANET, TDN2 and Coalition network access required. Access to NSANET requires a current CI polygraph. The contractor shall not access, download or further disseminate any special access data (i.e., intelligence, NATO, COMSEC, etc.) outside the execution of the defined contract requirements and without the guidance and written permission of the KO. Contractor personnel will not access Special Access Program material without prior approval from the KO. In the event that any special access is required, the CM must modify the requirements for the DD Form 254. All contract personnel must follow requirements in AR 25-2, Information Assurance and the INSCOM Acceptable Use Policy.

11c: The contractor requires access to classified source data in support of the work effort. Any extracts or use of such data requires the contractor to apply derivative classifications and markings consistent with the source documents. Use of Multiple Sources on the Derived From line necessitates compliance with the NISPOM, paragraph 4-208a, and the use of a bibliography. Additional notes: The contractor requires access to classified source data up to and including Top Secret in support of the work effort. Any extracts or use of such data requires the contractor to apply derivative classifications and markings consistent with the source documents. Use of Multiple Sources on the Derived From line necessitates compliance with the NISPOM, paragraph 4-208a, and the use of a bibliography 11d: Contractor must provide adequate storage at their facility for classified hardware to the level of TBD. Additional notes: Contractor must provide adequate storage at their facility for classified hardware to the level of Top Secret

11f: HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE THE U.S., PUERTO RICO, U.S. POSSESSIONS AND TRUST TERRITORIES

11h: REQUIRE A COMSEC ACCOUNT

11i: HAVE A TEMPEST REQUIREMENT

11j: HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

11k: BE AUTHORIZED TO USE THE DEFENSE COURIER SERVICE 11m: IF PROVIDED THIS TEXT SHOULD PROVIDE A COMPLETE DESCRIPTION FOR (OTHER) Additional notes: SI, TK, G, HCS access and TARP Training required.

US ARMY SCI ADDENDUM TO DD FORM 254

X (1)-This contract requires access to Sensitive Compartmented Information (SCI). The Commander, US Army Intelligence and Security Command (INSCOM), acting on behalf of the DA Deputy Chief of Staff (DCS), G-2 is the Cognizant Security Authority (CSA) for the US Army, has exclusive security responsibility for all SCI released to the contractor or developed under the contract and held within the Contractor's SCI Facility (SCIF) or Co-utilization Agreement (CUA).

X (2)-The Defense Intelligence Agency (DIA) has security inspection responsibility for SCI and the

Defense Security Service (DSS) retains responsibility for all collateral information released or developed under the contract and held within the DoD Contractor's SCIF. All DD Forms 254 prepared for contracts involving access to SCI under this contract must be processed through ACCS to the CM and Industrial Security Specialist for approval.

X (3)-The manuals, regulations, and directives checked below provide the necessary guidance for physical, personnel, and information security for safeguarding SCI, and are part of the security classification specification for this contract:

X (a)-ICD 503, Intelligence Community Information Technology Systems

Security Risk Management, Certification and Accreditation X (b)-ICD 704 Personnel Security Standards and Procedures Governing Eligibility for

Access to Sensitive Compartmented Information and Other Controlled Access Program Information

X (c)-IC Tech Spec-for ICD/ICS 705, Technical Specifications for Construction and Management of Sensitive Compartmented Information Facilities

X (d)-Signals Intelligence Security Regulations (SISR) (Available from the CM) X (e)-Imagery Policy Series (Available from the CM) X (f)-DoDM 5105 Vol 1 – 3 SCI Administrative Security Manual.

X (g)-AR 380-28, DA Special Security System X (h)-AR 25-2, Information Assurance (i)-AR 380-381, Special Access Programs X (j)-Army Handbook for SCI Contracts.

X (k)-Other

X (4)-Contract estimated completion date (PERIOD OF PERFORMANCE ONLY):

(NOTE: Option years are not to be included, as an option is not valid until exercised by the government.)

X (5)-The name, telephone number, and email and mailing address of the Contract Monitor (CM) and alternate for the SCI portion of this contract are: William Acevedo, Address: 8825 BEULAH STREET, FT BELVOIR, VA, 22060-5246, Phone: 571-515-7991, Email: william.acevedo2.civ@army.mil - Samuel Wilson, Address: 8825 BEULAH STREET, FT BELVOIR, VA, 22060-5246, Phone: 703-428-4457, Email:

samuel.f.wilson2.civ@mail.mil - Sophia Melakou, Address: 8825 BEULAH STREET, FT BELVOIR, VA, 22060-5246, Phone: 703-428-4955, Email: sophia.melakou.civ@army.mil - Akilah Gamble, Address: 8825 BEULAH STREET, FT BELVOIR, VA, 22060-5246, Phone: 571-515-7993, Email:

akilah.d.gamble.civ@army.mil (Additionally, identify the Security POC, phone number, and email address at the contractor’s/subcontractor’s location): (The CM and the contractor security officer must be registered in the Army Centralized Contracts and Security Portal (ACCS) at the level of contract, in order to process SCI actions)

X (6)-All DD Forms 254 prepared for contracts involving access to SCI under this contract must be processed through ACCS to the CM and Industrial Security Specialist for approval and to Contractor Support Element, USAINSCOM, ACofS Security, G2 for review and concurrence of the awarded contract.

X (7)-Visit certification to DoD locations is not required, as need to know and accesses is verified at the visiting facility. Non DoD locations the contractor must process request for SCI visit certification(s) through ACCS to the CM for approval and to Contractor Support Element (CSE) for review and processing. Visit certification request must be submitted at least ten (10) working days prior to the visit.

X (8)-Debriefings: All FSO’s/CSSO’s must properly debrief all contractors from SCI through ACCS.

FSO/CSSO’s must submit the debrief request NLT 7 days and NET 10 days before actual departure.

FSO’s/CSSO’s will separate all contractors from JCAVS after completion of debriefing.

X (9)-The contractor will not reproduce any SCI related material without prior written permission of the CM.

(10)-Security Classification Guides or extracts are attached or will be provided under separate cover.

X (11)-Electronic processing of SCI requires accreditation of the equipment in accordance with ICD

503 and AR 25-2. (Note: NATO security awareness briefing is required for access to JWICS indicated in blocks 10k or 11l of DD 254.).

X (12)-This contract requires a contractor Controlled Space or CUA

X (13)-Request for Indoctrination/Debrief Authority

X (14)-This contract requires (SI) (TK) (G) (HCS) (SAP) (Add others as required) Add others as required

X (15)-The contractor will perform SCI work under this contract at the following location (Name of government or contractor activity, SCI SMO or CAGE Code):

Companies:

Agencies: WDFKAA - USA NATIONAL GROUND INTELLIGENCE CENTER - CHARLOTT, W00YAA3 - USA INTELLIGENCE & SECURITY COMMAND / MISSION SUPP, W092AA - US EUROPEAN

COMMAND, W0ANAA2 - USAREUR, W095AA - HQ US FORCES KOREA, UIC16 - USA SOUTHERN

COMMAND / SIGNAL ACTIVITY - MIAMI, F, W0Z1AA3 - HQ, DEPARTMENT OF THE ARMY, W0VPAA3 - US Army Combined Arms Center - FT LEAVENWORTH, K, W4T1AA - US CENTRAL COMMAND, W6VAAA - 780th Military Intelligence Brigade//IACN-S2//, WND0AA - 513TH MI BDE, WNERAA - 1ST IO COMMAND, WND199 - 66TH MI GRP, W00YAA2 - USA INTELLIGENCE & SECURITY COMMAND - FT BELVOIR,, WND299 - 470TH MILITARY INTELLIGENCE BRIGADE, WATGA33 - USARCENT, W6UXAA - CYBER COMMAND/2ND ARMY, W096AA - HQ, US SOUTHERN COMMAND, W0U566 - Cyber Center of Excellence (CCoE), wbu6aa - ACIC- 902d Military Intelligence Group, W4FG183 - US CENTRAL COMMAND (COMBINED FORCES COMMAND, W4FG18 - USFOR-A/NKC (SSO), WDLLT03 - 224TH MI BN, 116TH MI BDE, INSCOM, W6RFAA - 0706 MI GRP, WND1X1 - 66TH MI GP, WNAGXA3 - JTF GTMO USSOUTHCOM SSO, W6VBAA - Ground Intelligence Support Activity, WH9AAA - 501ST MI BDE, W4VY16 - GISA, W4FG093 - US FORCES IRAQ, RCSKIFC - KANDAHAR, WJHEAA3 - HQ SU SETAF, CAS, WND6X1 - 500th MI Brigade, WNGGAA - 116TH MI BDE FORT GORDON, WND2X13 - 470TH MIB, WJWZAA - TF ODIN, W001AA - 704th MI BDE, W3NRAAL2 - NGA East Campus, w6vb06 - GISA PACIFIC, WH9AAA - 532ND MI BN , (16)-The contractor identified in Block 6 is a Multiple Facility Organization (MFO) and is authorized to submit DD254 and SCI Addendum for the following SCI locations (Facility Name and CAGE Code).

(17)- SCI Courier Requirement