Attachment 0006 DD254 dated November 11 2022.pdf

CLASSIFICATION (When filled in): Unclassified

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AEM LiveCycle Designer

DD FORM 254, APR 2018

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

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED

(See Instructions)

Secret

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

None (See instructions)

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

a. PRIME CONTRACT NUMBER (See instructions.)

TBD

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20221004

b. REVISED (Supersedes all previous specifications.)

REVISION NO. DATE (YYYYMMDD)

c. FINAL (Complete Item 5 in all cases.) DATE (YYYYMMDD)

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 classified material is authorized for the period of:

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

a. NAME, ADDRESS, AND ZIP CODE Apptricity Government Services L.P.

5605 N. MacArthur Blvd, Suite 900 Irving, TX 75038-2630

b. CAGE CODE

49ZN6

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional) Irving Field Office Defense Security Service (IOFSI) 5800 E. Campus Circle Drive, Suite 218A Irving, TX 75063 Field Office Chief: Ms. Jennifer Norden

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) Add Row Remove last Row Delete All Rows

a. NAME, ADDRESS, AND ZIP CODE

TBD

b. CAGE CODE

TBD

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

TBD

8. ACTUAL PERFORMANCE (Click button to add more locations.) Add Row Remove last Row Delete All Rows

a. LOCATION(S) (For actual performance, see instructions.)

TC-AIMS II Integration Facility

b. CAGE CODE

(If applicable, see Instructions.)

49ZN6

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional) Irving Field Office Defense Security Service (IOFSI) 5800 E. Campus Circle Drive, Suite 218A Irving, TX 75063 Field Office Chief: Ms. Jennifer Norden

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Theater Operations (TOPS) Support for Transportation Coordinators' Automated Information System II for Product Lead Logistics Information Systems (PL LIS).

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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 GOVERMENT INFORMATION

d. FORMERLY RESTRICTED DATA i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

e. NATIONAL INTELLIGENCE INFORMATION:

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI) (See instructions.)

k. OTHER (Specify) (See instructions.)

CAC and NIPRnet

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.)

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.)

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE, STORE, AND GENERATE CLASSIFIED

INFORMATION OR MATERIAL

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE

e. PERFORM SERVICES ONLY

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

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

TERRITORIES

g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE

TECHNICAL INFORMATION CENTER (DTIC) OR OTHER

SECONDARY DISTRIBUTION CENTER

h. REQUIRE A COMSEC ACCOUNT

i. HAVE A TEMPEST REQUIREMENT

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE

l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED

INFORMATION (CUI).

(DoD Components: refer to DoDM 5200.01, Volume 4 only for specific CUI protection requirements. Non-DoD Components: see instructions.)

m. OTHER (Specify) (See instructions.)

1. Eligibility for assignment to ADP I, II, III (IT-1, IT-2 and IT-3) positions.

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)

DIRECT THROUGH (Specify below)

Program Executive Office Enterprise Information Systems, Headquarters, 9350 Hall Rd. Fort Belvoir, VA 22060-5526

Public Release Authority:

PEO EIS, Chief, Strategic Communications Division

13. SECURITY GUIDANCE Add Signature Remove last Signature Delete All Signatures

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.)

REF: 10(j): Controlled Unclassified Information (CUI) Protection of Controlled Unclassified Information (CUI) [formerly For Official Use Only (FOUO)], contractual, and Privacy Act information, shall be marked and protected IAW DoDI 5200.48 (Controlled Unclassified Information (CUI)), AR 25-55 (Freedom of Information Act Program) and Chapter 5, AR 380-5 (DA Information Security Program). All CUI generated and/or provided under this contract shall be safeguarded and marked as IAW DoDI 5200.48. Personally Identifiable Information (PII) shall be protected IAW the Privacy Act (5 USC 552a), AR 25-1, and DODI 8500.2 Information Assurance (IA) implementation.

REF: 10(k) OTHER - CAC and NIPRNET All contractors must apply for Common Access Card (CAC), and NIPRnet and network access. All contractors shall have the appropriate personnel security investigation (PSI) completed and favorably adjudicated for eligibility at the SECRET at the time of the contract award.

REF: 11(j): OPERATIONS SECURITY (OPSEC) REQUIREMENTS - The contractor shall comply with PEO-EIS PMO's OPSEC standard operating procedure (SOP) in accordance with AR 530-1. The OPSEC Plan is to protect classified and/or Controlled Unclassified

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Information critical information used at the PEO-EIS government or non-government cleared classified controlled facility during the performance of this contract.

REF: 11(l): RECEIVE, STORE OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI) - Contractor is authorized to receive, store, or generate CUI in the performance of this contract. Information designated as CUI, e.g., FOUO generated under this contract shall be controlled, handled, stored, marked, safeguarded, transmitted and destroyed IAW DoDM 5200.01, DoDM 5400.07, AR 380-5, AR 25-2, AR 25-55. The contractor may disseminate FOUO information to their employees that have a need-to-know. The contractor shall report the unauthorized disclosure of CUI to the COR.

REF 11(m): OTHER -

DOD 5200.2-R, DOD Personnel Security Program, requires DOD contractor personnel, who perform work on sensitive automated information systems (AISs), to be assigned to positions which are designated at one of three sensitivity levels (ADP-I, ADP-II or ADP III).

These designations equate to Critical Sensitive, Non-critical Sensitive and Non-sensitive. All personnel performing on this contract shall hold a valid personnel security clearance at the Secret or Interim Secret clearance level.

(1) Any person with the ability to affect the security posture of the TC-AIMS II domain (specifically System Administrators with Unix Root or Windows Administrator privileges and all Applications Development personnel) are designated as IT-I positions (as defined in AR 25-2) and will require a minimum of a DoD Secret Clearance IAW AR 25-2 and DoD 8570.01-M, with the exception of key positions identified in the PWS that require a DoD Secret Clearance at contract award.

(2) The sensitivity level of TC AIMS II application for users is ADP-III. Users require a National Agency Check Inquiry (NACI) prior to being granted access to the system. Users can receive, enter, and/or modify information in an information system/application or database to which they are authorized access.

Any classified information generated in the performance of this contract shall be classified according to the markings shown on the source material.

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

Add Attachment View Selected Attachment Remove Selected Attachment

Product Lead Logistics Information Systems (PL LIS) Attn: SFAE-PSA-LS, 441 1st St., BLDG 1108, Fort Lee

VA 23801-1507

NAME & TITLE OF REVIEWING OFFICIAL

Lonna Freeland Contracting Officer Representative

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 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.

No Yes 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 - RI

b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)

W52P1J

c. ADDRESS (Include ZIP Code) Army Contracting Command-Rock Island

(ACC-RI)

3055 Rodman Ave, Bldg. 62 3 Rock Island, IL 61299-7630

d. POC NAME

Geringer, Benjamin L.

e. POC TELEPHONE (Include Area Code)

+1 (309) 782-1784

f. EMAIL ADDRESS (See Instructions) benjamin.l.geringer.civ@army.mil

17. CERTIFICATION AND SIGNATURES

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DD FORM 254, APR 2018

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)

Courty, Stacy L.

b. TITLE

Security Manager

c. ADDRESS (Include ZIP Code) Attn: SFAE-PS 9350 Hall Road, Suite 206 Fort Belvoir, VA 22060-5526

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

W52P1J

e. CAGE CODE OF THE PRIME CONTRACTOR

(See Instructions.)

49ZN6

f. TELEPHONE (Include Area Code)

+1 (703) 806-2490

g. EMAIL ADDRESS (See Instructions) stacy.l.coutry.civ@army.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

20221107

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

a. CONTRACTOR

b. SUBCONTRACTOR

c. COGNIZANT SECURITY OFFICE FOR PRIME AND

SUBCONTRACTOR

d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY

ADMINISTRATION

e. ADMINISTRATIVE CONTRACTING OFFICER

f. OTHER AS NECESSARY (If more room is needed, continue in Item 13 or on additional page if necessary.)

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)

5605 N. MacArthur Blvd, Suite 900 Irving, TX 75038-2630

Defense Security Service (IOFSI) 5800 E. Campus Circle Drive, Suite 218A Irving, TX 75063 Field Office Chief: Ms. Jennifer Norden

Defense Security Service (IOFSI) 5800 E. Campus Circle Drive, Suite 218A Irving, TX 75063 Field Office Chief: Ms. Jennifer Norden

Protection of Controlled Unclassified Information (CUI) [formerly For Official Use Only (FOUO)], contractual, and Privacy Act information, shall be marked and protected IAW DoDI 5200.48 (Controlled Unclassified Information (CUI)), AR 25-55 (Freedom of Information Act Program) and Chapter 5, AR 380-5 (DA Information Security Program). All CUI generated and/or provided under this contract shall be safeguarded and marked as IAW DoDI 5200.48. Personally Identifiable Information (PII) shall be protected IAW the Privacy Act (5 USC 552a), AR 25-1, and DODI 8500.2 Information Assurance (IA) implementation.

REF: 10(k) OTHER - CAC and NIPRNET All contractors must apply for Common Access Card (CAC), and NIPRnet and network access. All contractors shall have the appropriate personnel security investigation (PSI) completed and favorably adjudicated for eligibility at the SECRET at the time of the contract award.

REF: 11(j): OPERATIONS SECURITY (OPSEC) REQUIREMENTS - The contractor shall comply with PEO-EIS PMO's OPSEC standard operating procedure (SOP) in accordance with AR 530-1. The OPSEC Plan is to protect classified and/or Controlled Unclassified Information critical information used at the PEO-EIS government or non-government cleared classified controlled facility during the performance of this contract.

REF: 11(l): RECEIVE, STORE OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI) - Contractor is authorized to receive, store, or generate CUI in the performance of this contract. Information designated as CUI, e.g., FOUO generated under this contract shall be controlled, handled, stored, marked, safeguarded, transmitted and destroyed IAW DoDM 5200.01, DoDM 5400.07, AR 380-5, AR 25-2, AR 25-55. The contractor may disseminate FOUO information to their employees that have a need-to-know. The contractor shall report the unauthorized disclosure of CUI to the COR.

REF 11(m): OTHER -

DOD 5200.2-R, DOD Personnel Security Program, requires DOD contractor personnel, who perform work on sensitive automated information systems (AISs), to be assigned to positions which are designated at one of three sensitivity levels (ADP-I, ADP-II or ADP III). These designations equate to Critical Sensitive, Non-critical Sensitive and Non-sensitive. All personnel performing on this contract shall hold a valid personnel security clearance at the Secret or Interim Secret clearance level.

(1) Any person with the ability to affect the security posture of the TC-AIMS II domain (specifically System Administrators with Unix Root or Windows Administrator privileges and all Applications Development personnel) are designated as IT-I positions (as defined in AR 25-2) and will require a minimum of a DoD Secret Clearance IAW AR 25-2 and DoD 8570.01-M, with the exception of key positions identified in the PWS that require a DoD Secret Clearance at contract award.

(2) The sensitivity level of TC AIMS II application for users is ADP-III. Users require a National Agency Check Inquiry (NACI) prior to being granted access to the system. Users can receive, enter, and/or modify information in an information system/application or database to which they are authorized access.

Any classified information generated in the performance of this contract shall be classified according to the markings shown on the source material.

text: Product Lead Logistics Information Systems (PL LIS) Attn: SFAE-PSA-LS, 441 1st St., BLDG 1108, Fort Lee VA 23801-1507

Contracting Officer Representative

3055 Rodman Ave, Bldg. 62 3 Rock Island, IL 61299-7630 Address: Attn: SFAE-PS 9350 Hall Road, Suite 206 Fort Belvoir, VA 22060-5526