Attachment 3_DD Form 254 SEP 2020 (CURRENT).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PREVIOUS EDITION IS OBSOLETE.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:

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)

212 Lukasik (Room 230) Hurlburt Field, FL. 32544 Phone: 850-884-5143 1SOW.IPC.IndustrialSecurity@us.af.mil

CSO: 1 SOW/IP

212 Lukasik (Room 230) Hurlburt Field, FL. 32544 Phone: 850-884-5143 1SOW.IPC.IndustrialSecurity@us.af.mil

CSO: 1 SOW/IP

212 Lukasik (Room 230) Hurlburt Field, FL. 32544 Phone: 850-884-5143 1SOW.IPC.IndustrialSecurity@us.af.mil

CSO: 1 SOW/IP

212 Lukasik (Room 230) Hurlburt Field, FL. 32544 Phone: 850-884-5143 1SOW.IPC.IndustrialSecurity@us.af.mil

100 Bartley St Hurlburt Fld, FL 32544 Location: 371 SOCTS/IFTU 232 Hartson St Hurlburt Fld, FL 32544 Building 90069 (Room 111)

Location: 11 SOIS 219 Terry Ave Hurlburt Fld, FL 32544 Location: 1 SOSS/IN 618 Cruz Ave Hurlburt Fld, FL 32544 Building 90758

2. Classified markings on all working, draft, and final copies of deliverable material shall be in accordance with Executive Order 13526, The Controlled Access Program Coordination Office (CAPCO) guidelines, DOD 5220.22-M, DoD 5200.01, V-2 and applicable instructions contained in the respective security classification guides.

3. All classified material provided shall be returned by the contractor at contract completion. Individuals are responsible for safeguarding classified information entrusted to them.

4. Use only AF certified AIS for performance on base and will comply with all AF AIS procedures.

5. The contractor is authorized to courier classified material, up to SECRET IAW AFI 16-1404, Information Security Program Management, and under the approval of the Contracting Officer, Commander, and Company Representative.

Ref item 10f: The contractor requires access to SAP material and must adhere to the special access instructions, requirements, procedures developed by the specific SAP program manager. Read-in's will take place at those locations as required.

Ref Item 10g: Access to NATO information requires a final US Government clearance at the appropriate level. The AFSOC NATO Registry can be contacted at 850-884-5909.

Ref item 10h: This item includes any foreign Government information except NATO. Access to foreign government information requires a final US Government clearance at the appropriate level. Contractor employees will be briefed, and acknowledge in writing, their responsibilities for handling foreign government information prior to being granted access. The contractor will maintain strict compliance with NISPOM Ch 10. Prior approval of the contracting activity is required for subcontracting. All foreign visits will be coordinated in advance with the AFSOC Foreign Disclosure Office (850) 884-4096.

Ref item 11g: Access to DTIC will require contractor to submit DD Form 1540 and 1541 to user agencies for approval.

Ref item 11i: The OPR for the Tempest is not the office shown in item 13 of this form. However, the contractor requires access to Tempest and must adhere to the Tempest instructions, requirements, procedures developed by the specific Tempest Program Manager.

Ref Item 11j: Contractor is to submit requests through the Contracting Officer for OPSEC Program Manager review and public release authorization. The Contracting Officer will provide contractor with written approval/disapproval. Information requiring AF or DoD–level review will be reviewed by the unit’s OPSEC Program Manager or Coordinator who will in-turn forward to the entry-level public affairs office through the AFIMSC Public Affairs Office to the Secretary of the Air Force, Office of Public Affairs, Security and Review Division (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330-1690.” MAJCOM/DRUs will send information requiring AF or DoD-level review directly to SAF/PAX.

**** See attached addendums for items 10a, e (1&2), f, h, j, k and 11i, j and l **** text: HQ AFSOC/A2X 850-884-6893 text: AFSOC/SA 850-884-0301 text: AFSOC/SSO 850-884-6588 text: 1 SOW/IPC 850-884-5143

Program Manager rep: JOHN M. GORDON Program Security Officer rep: DARRYL SMALLER Security Manager rep: PARRISH HOLLINGSWORTH Chief, Industry Security

Bldg 90333 Hurlburt Field, FL 32544 Address: 427 Cody Ave Hurlburt Field, FL 32544