Attachment 2 - DD Form 254.pdf

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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PREVIOUS EDITION IS OBSOLETE.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:

May 31, 2022 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.)

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 254, DoD Contract Security Classification Specification

705 Washington Blvd, room 162 Fort Eustis, VA 23604

Ref 10j: (1) DoD Components: refer to DoDM 5200.01, Volume 4, "DoD Information Security Program: Controlled Unclassified Information (CUI), "available at http://www.esd.whs.mil/DD/DoD-Issuances/. when considering protection for CUI.

(2) Non-DoD Components must consult with their Component-specific information security policy office to determine if they have any existing authority by law, government-wide policy or government-wide regulation to impose this requirement.

This contract will consist of one base year and two option years; contract awarded**TBD by the KO**

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. Note: Once the KO has modified the requirements for the DD254, the contractor must complete the SIPRNET Access request form, along with the modified DD254, and forward to the KO prior to receiving access. A NATO awareness brief will also be required for all contractors prior to access to the SIPRNET. Access to NATO is not required in performance of duties.

Ref 11e: Contractor requires a TOP SECRET and SECRET clearance to review the training impacts to training in classified documents.

Contractor performance is restricted to official business supporting Army Training Support Center. Government agency or activity provides security classification guidance for performance of this contract. Submit visit request via Joint Personnel Adjudication System (JPAS) to the organization’s Security Management Office (SMO).

Contractors shall ensure an owning relationship is established in JPAS for each individual requiring access to classified military information in performing duty in support of the Future Training Capability (FTC) Analyst Contract.

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

The investigative basis for personnel security clearances shall be in accordance existing Department of Defense (DoD) policy. Eligibility based on out of date investigations, i.e., TOP SECRET (5-years), SECRET (10 years), and CONFIDENTAIL (15 years) 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 required investigations are submitted.

The National Industrial Security Program Operating Manuel (NISPOM), February 28, 2006 applies as well as Industrial Security Letters (ISL).

All contractor personnel shall be properly briefed by the organization at the start of working on this task order and debriefed at the end of the period of performance or earlier departure.

COR: Walter H. Orthner

GS-13, ATSC/TSSO

Security Office Representative Contract Expiration Date: 28 September 2023

Chief, Information Protection

Fort Eustis, VA 23604 Address: 633 ABW/IP 705 Washington Blvd, room 162 Fort Eustis, VA 23604