Attachment 11 -DD 254.pdf

DEPARTMENT OF DEFENSE

CONTRACT SECURITY CLASSIFICATION SPECIFICATION

(Please read Instructions BEFORE completing this application.) (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. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED (See instructions.)

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/MATERIAL

REQUIRED AT CONTRACTOR FACILITY

Top Secret None (See instructions)

DUE DATE (YYYYMMDD)c. SOLICITATION OR OTHER NUMBER

b. SUBCONTRACT NUMBER

TBD

a. PRIME CONTRACT NUMBER (See instructions.)

DATE (YYYYMMDD)

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

DATE (YYYYMMDD)REVISION NO.b. REVISED (Supersedes all previous specifications.)

20191212

DATE (YYYYMMDD)

a. ORIGINAL (Complete date in all cases.)

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

YES. If Yes, complete the following:NO4. IS THIS A FOLLOW-ON CONTRACT?

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

YES. If Yes, complete the following:NO5. IS THIS A FINAL DD FORM 254?

TBD

c. COGNIZANT SECURITY OFFICE (CSO) (Name, Address, ZIP Code, Telephone)

TBD

b. CAGE CODE

TBD

a. NAME, ADDRESS, AND ZIP CODE

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

c. COGNIZANT SECURITY OFFICE(S) (CSOs) (Name, Address, ZIP Code, Telephone)

b. CAGE CODEa. NAME, ADDRESS, AND ZIP CODE

7. SUBCONTRACTOR(S) (Click button to add more subcontractors.)

633 ABW/IP, 705 Washington Blvd., Suite 162, Ft. Eustis, VA OR the appropriate CSO at Ft. Gordon, Ft. Leavenworth, Ft. Leonard Wood, Charlottesville, VA, Ft. Rucker, and Ft. Bliss

c. COGNIZANT SECURITY OFFICE(S) (CSOs) (Name, Address, ZIP Code, Telephone) (If applicable, see instructions.)

b. CAGE CODE (If applicable, see instructions.)

Multiple locations (see continuation page 3) USATSC, Bldg. 3308/3312Wilson Ave., Ft. Eustis, VA 23604 Cyber CoE, 405 Barnes Ave., Ft. Gordon, GA 30905 CGSC, 100 Stimson Ave., Ft. Leavenworth, KS 66027

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

8. ACTUAL PERFORMANCE (Click button to add more locations.)

Contractor will provide technical support for the Lifelong Learning Centers at Forts Eustis, Gordon, Leavenworth, and Leonard Wood, the Judge Advocate General Legal Center and School (TJAGLCS), Charlottesville, VA, the US Army Warrant Officer Career College (WOCC) at Fort Rucker, AL, and the US Army Sergeants Major Academy (USASMA), Ft. Bliss, TX for systems owned by the U.S. Army. Contractor will provide limited support to SIPR systems at Fort Gordon only in reference to setup, maintenance, warranty items, and patching in coordination with the Network Enterprise Center.

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT (Click here if more space is needed.)

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

d. FORMERLY RESTRICTED DATA

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

b. RESTRICTED DATA

e. NATIONAL INTELLIGENCE INFORMATION:

f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

k. OTHER (Specify) (See instructions.)

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

i. ALTERNATIVE COMPENSATORY CONTROL MEASURES (ACCM)

INFORMATION

h. FOREIGN GOVERMENT INFORMATION

g. NORTH ATLANTIC TREATY ORGANIZATION (NATO) INFORMATION

JWICS and SIPRNet Access. NATO briefing required.

DD FORM 254, NOV 2017 PREVIOUS EDITION IS OBSOLETE. Adobe LiveCycle Designer ES4

CLASSIFICATION (When filled in):

UNCLASSIFIEDCLASSIFICATION (When filled in):

UNCLASSIFIED

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

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.)

h. REQUIRE A COMSEC ACCOUNT

k. BE AUTHORIZED TO USE THE DEFENSE COURIER SERVICE (DCS)

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

i. HAVE A TEMPEST REQUIREMENT

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE, STORE, AND GENERATE CLASSIFIED INFORMATION OR

MATERIAL

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

e. PERFORM SERVICES ONLY

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE 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.)

See Block 13.

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)

DIRECT

Installation Security Office, 633 Air Base Wing/Information Protection, JBLE, Fort Eustis, VA 23604

633 Public Affairs Office, JBLE, Fort Eustis, VA 23604 THROUGH (Specify) PUBLIC RELEASE AUTHORITY:

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. Click button to add additional pages as needed to provide complete guidance.)

a. This is a service contract providing engineering, administration, and programming support for LLC mission servers. Contractors may be required to work with classified networks and may be required to read classified documents.

b. Personnel performing on this contract must be U.S. citizens.

c. The investigative basis for personnel security clearances should be IAW existing DoD policy. Clearances based on investigations that are out of date, i.e., TOP SECRET (6 yrs), SECRET (10 yrs), and CONFIDENTIAL (15 yrs) must be processed for a Periodic Reinvestigation within 10 days of being assigned to the contract. Contractors will not be allowed access to classified military information (CMI) until correct access level is reflected in Joint Personnel Adjudication System (JPAS).

14. ADDITIONAL SECURITY REQUIREMENTS. Requirements, in addition to NISPOM requirements for classified information, are established for this contract.

YesNo (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. Use Item 13 or click button if additional space is needed.)

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. Click button or use Item 13 if additional space is needed.)

YesNo

757-878-9924

e. POC TELEPHONE (Include Area Code.)

cheryl.s.cassell.civ@mail.mil

f. EMAIL ADDRESS (See instructions.)

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

d. AAC OF THE CONTRACTING OFFICE (See instructions.)

e. CAGE CODE OF THE PRIME CONTRACTOR (See instructions.)

Cheryl Cassell

d. POC NAME (See instructions.)

Bldg 3308 Wilson Ave.

Fort Eustis, VA 23604

c. ADDRESS (Include ZIP Code.)

ATSC/TCM ATIS

a. GCA NAME

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

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

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.

a. TYPED NAME OF CERTIFYING OFFICIAL (Last, First, Middle Initial) (See instructions.)

Connolly, Robert E.

757-878-5230

f. TELEPHONE (Include Area Code.)

robert.e.connolly3.civ@mail.mil

g. EMAIL ADDRESS (See instructions.) h. SIGNATUREh. DATE

Chief, Information Protection

b. TITLE 633rd ABW/IP 705 Washington Blvd.

Fort Eustis, VA 23604

c. ADDRESS (Include ZIP Code.)

Contracting Officer:

Rhoda-Harrison Spence 705 Washington Blvd., Suite 114 Fort Eustis, VA 23604

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

e. ADMINISTRATIVE CONTRACTING OFFICER

d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION

c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR

b. SUBCONTRACTOR

a. CONTRACTOR

DD FORM 254 (BACK), NOV 2017

W911S0

UNCLASSIFIEDCLASSIFICATION (When filled in):

UNCLASSIFIEDCLASSIFICATION (When filled in):

CONNOLLY.ROB

ERT.E.1008572778

Digitally signed by

CONNOLLY.ROBERT.E.1008572

Date: 2019.12.12 09:30:05 -05'00'

c. COGNIZANT SECURITY OFFICE(S) (Name, Address, ZIP Code, Telephone)b. CAGE CODE N/A

a. NAME, ADDRESS, AND ZIP CODE

7. SUBCONTRACTOR(S) (Continued)

c. COGNIZANT SECURITY OFFICE(S) (Name, Address, ZIP Code, Telephone)b. CAGE CODEa. NAME, ADDRESS, AND ZIP CODE

c. COGNIZANT SECURITY OFFICE(S) (Name, Address, ZIP Code, Telephone)b. CAGE CODEa. NAME, ADDRESS, AND ZIP CODE

c. COGNIZANT SECURITY OFFICE(S) (Name, Address, ZIP Code, Telephone)b. CAGE CODEa. NAME, ADDRESS, AND ZIP CODE

c. COGNIZANT SECURITY OFFICE(S) (Name, Address, ZIP Code, Telephone)b. CAGE CODE MSCoE, Bldg. 3000 MSCoE Lp., Ft. Leonard Wood, MO 65473 TJAGLCS, 600 Massie Rd., Charlottesville, VA 22903 USAWOCC, 5302 Outlaw St. - Swartworth Hall, Ft. Rucker, AL 36362

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

c. COGNIZANT SECURITY OFFICE(S) (Name, Address, ZIP Code, Telephone)b. CAGE CODEa. LOCATION(S) (For actual performance, see instructions.)

c. COGNIZANT SECURITY OFFICE(S) (Name, Address, ZIP Code, Telephone)b. CAGE CODEa. LOCATION(S) (For actual performance, see instructions.)

c. COGNIZANT SECURITY OFFICE(S) (Name, Address, ZIP Code, Telephone)b. CAGE CODE USASMA, 11291 SGT E. Churchill Street, Ft. Bliss, TX 79918-8002

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

8. ACTUAL PERFORMANCE (Continued)

N/A

9. GENERAL UNCLASSIFIED IDENTIFICATION OF THIS PROCUREMENT (Continued)

DD FORM 254, NOV 2017 PagesofContinuation Page

UNCLASSIFIED

CLASSIFICATION (When filled in): UNCLASSIFIED

CLASSIFICATION (When filled in):

N/A

15. INSPECTIONS (Continued)

N/A

14. ADDITIONAL SECURITY REQUIREMENTS (Continued)

CONTINUATION - DD FORM 254

ITEM 13

d. Contractors shall ensure an owning relationship is established in JPAS for each individual performing duty in support of this Performance Work Statement (PWS)/task order who require access to CMI in performance of their duties. Visit requests (VR) shall be sent via JPAS to the appropriate Security Management Office (SMO).

e. The contract will comply with applicable Army Regulations, Air Force Instructions and local command policies and procedures governing the protection of CMI and Controlled Unclassified Information (CUI) material.

f. The National Industrial Security Program Office Operating Manual (NISPOM), February 28, 2006 and the Industrial Security Letters apply.

g. Ref 10j: Controlled Unclassified Information (CUI) generated and/or provided under this contract shall be safeguarded and marked as specified in DoD 5200.1, Volume 1-4.

h. Ref 10k: Secret Internet Protocol Network (SIPRNet) access required. 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 Contracting Officer (KO). In the event that any special access is required, the KO must modify the requirements for the DD Form 254.

The Contractor must complete the SIPRNet access request form, along with the modified DD Form 254, and forward to the KO prior to receiving access.

A NATO awareness brief will be required for all Contractors prior to access to the SIPRNet. Access to NATO information is not required.

i. Ref 11a: Contractor performance is restricted to USATSC, Building 3308 Wilson Ave., Ft. Eustis, VA, Cyber CoE, 405 Barnes Ave., Ft. Gordon, GA, CGSC, 100 Stimson Ave., Ft. Leavenworth, KS, MSCoE, Building 3000 MSCoE Loop, Ft. Leonard Wood, MO, the Judge Advocate General Legal Center and School, 600 Massie Rd., Charlottesville, VA, USAWOCC, 5302 Outlaw St. - Swartworth Hall, Ft. Rucker, AL, and USASMA, 11291 SGT E.

Churchill Street, Ft. Bliss, TX. Government agency or activity will provide security classification guidance for performance of this contract. Submit VR via Joint Personnel Adjudication System (JPAS) to the Security Management Office for need-to-know verification for each contractor requiring access to classified military information (CMI) and/or systems in performance of their duties in support of this Performance Work Statement (PWS). Contractor shall ensure the required access level is accurately reflected in JPAS. VRs must be sent to the Security Management Offices (SMOs) W3E9AA6 and

W4W6AA.

j. Contractor will not store, generate, or incorporate any classified data into any documentation without permission of the user agency.

k. All contractor personnel shall be properly briefed by the organization at the start of this contract/task order and debriefed at the end of the period of performance.

13. SECURITY GUIDANCE (Continued)

PagesofContinuation PageDD FORM 254, NOV 2017

UNCLASSIFIED

CLASSIFICATION (When filled in): UNCLASSIFIED

CLASSIFICATION (When filled in):

Additional persons assisting with completion of form (signatures and titles)