Attachment 3 - Draft DD254.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PREVIOUS EDITION IS OBSOLETE.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)

985 Macon Street Robins AFB GA 31098 478-222-1977 78abw.ipworkflow@us.af.mil

CSO: 355 FW/IP

3405 South Fifth Street Davis-Monthan AFB AZ 85707-4007 520- 228-1233 355FWIP@us.af.mil

CSO: 119 WG/IP

1400 32nd Avenue North Fargo ND 58102-1000 701- 451-8290 usaf.nd.119-wg.mbx.ip@mail.mil

CSO: 178 WG/IP

5319 Regula Avenue Springfield OH 45502-9818 937- 525-2569 usaf.oh.178-wg.mbx.178-isrw-ip@mail.mil

CSO: 163 ATKW/IP

1620 Graeber Street, Building 2270 March ARB CA 92518-1635 951- 655-2540 usaf.ca.163-rw.mbx.ip@mail.mil

CSO: 174 WG/IPO

6001 East Molloy Road, Building 174 Syracuse NY 13211-7099 315- 233-2541 usaf.ny.174-atkw.mbx.ip@mail.mil CSO: 147 ATKW/IP (via 147 SFS) 14657 Sneider Street, Building 1057 Houston TX 77034-5582 281- 929-2190 usaf.tx.147-rw.mbx.ip@mail.mil

CSO: 914 ARW/IP

2720 Kirkbridge Drive, Building 800 Niagara Falls NY 14304-5001 716- 236-2446 914AW.IP@us.af.mil

CSO: 118 WG/IP

240 Knapp Boulevard, Building 810 Nashville TN 37217-2556 615- 660-8007 usaf.tn.118-wg.mbx.wg.ip@mail.mil

CSO: 132 WG/IP

3100 McKinley Avenue, Building 100 Des Moines IA 50321-2720 515- 261-8275 usaf.ia.132-wg.mbx.information-protection@mail.mil CSO: 111 ATKW/IP (via 111 SFS) 2018 Itami Street, Building 219 Horsham PA 19044 215- 323-7145 usaf.pa111-atkw.mbx.atwk-ip@mail.mil

CSO: 188 FW/IP

4850 Leigh Avenue, Building 102 Fort Smith AR 72903 479- 573-5106 usaf.ar.188-wg.mbx.ip-info-protection@mail.mil

CSO: 110 WG/IP

3545 Mustang Avenue Battle Creek MI 49037-5509 269- 967-3518 usaf.mi.110-atkw.mbx.information-protection@mail.mil

CSO: 27 SOW

300 Air Commando Way

CAFB, NM 88103

CSO: 2 SOS

814 Tully Street Hurlburt Field, FL 32544

CSO: 65 SOS

Building 90137 Hurlburt Field, FL 32544

CSO: 11 SOIS

219 Terry Avenue Hurlburt Field, Florida 32544

CSO: 20 FW/IP (ACC)

524 Nelson Avenue Shaw AFB SC 29152-5056 803-895-3638;

20FWIP@us.af.mil

CSO: 49WG/IP (ACC)

490 First Street, Ste 2500 Holloman AFB, NM 88330 505-572-1020 49.FW.Information.Protection@us.af.mil

CSO: 509 BW/IP (ACC)

509 Spirit Blvd., Ste 213 Whiteman AFB, MO 65305-1154 660-687-5809 509.BW.IP.Information.Protection@us.af.mil

CSO: 28 BW/IP (AFGSC)

2740 Eaker Drive, Ste 204-B Ellsworth AFB, SD 57706-4829 605-385-2433 28bw.ip@us.af.mil

CSO: 99 ABW/IP (ACC)

4311 Carswell Avenue, Suite 205 Nellis AFB NV 89191-7069 702-652-4434 99ABW.IP@us.af.mil

CSO: 99 ABW/IP (ACC)

4311 Carswell Ave Ste 205 Nellis AFB NV 89191-7069 702-652-4434 99ABW.IP@us.af.mil

CSO: 99 ABW/IP (ACC)

4311 Carswell Ave Ste 205 Nellis AFB NV 89191-7069 702-652-4434 99ABW.IP@us.af.mil

255 Perry Street Robins AFB GA 31098 Location: [Arizona Air National Guard (ANG), 162d Wing]

214 ATKS 5262 East Gafford Way, Building 78 Davis-Monthan AFB AZ 85707 Location: [North Dakota ANG, Hector Field-Fargo ANGB]

119 WG

1400 32nd Avenue North, Building 208 Fargo ND 58102 Location: [Ohio ANG, Springfield-Beckley Municipal Airport]

178 WG 983 A Avenue, Building 146 Springfield OH 45502-9823 Location: [California ANG, March Air Reserve Base (ARB)]

163 ATKW

2145 Graeber Street, Building 117 March ARB CA 92518-1684 Location: [New York ANG, Hancock Field ANGB]

174 ATKW

6001 East Molloy Road, Building 643 Syracuse NY 13211-7099 Location: [Texas ANG, Ellington Joint Reserve Base]

147 ATKW

14657 Sneider Street, Building 1191 Houston TX 77034-5582 Location: [New York ANG, Niagara Falls Air Reserve Station]

107 ATKW

9910 Blewitt Avenue, Building 912 Niagara Falls NY 14304-6001 Location: [Tennessee ANG, Berry Field ANGB]

118 WG 240 Knapp Boulevard, Building 720 Nashville TN 37217-2556 Location: [Iowa ANG, Des Moines International Airport]

132 WG 3100 McKinley Avenue, Building 430 Des Moines IA 50321-2720 Location: [Pennsylvania ANG, Horsham Air Guard Station]

111 ATKW

1251 Fairchild Street, Building 203 Horsham PA 19044 Location: [Fort Smith Regional Airport, Arkansas ANG, Ebbing ANGB, Hangar 200]

188 WG

4850 Leigh Avenue, Building 108 Fort Smith AR 72903-6018 Location: [Michigan ANG, Battle Creek ANGB]

110 WG

3545 Mustang Avenue, Bldg 6914 Battle Creek MI 49037-5509 Location: 27 SOW Cannon Air Force Base Clovis, NM 88103 Location: 2 SOS Hurlburt Field Eglin AFB, FL 32544 Location: 65 SOS Hurlburt Field Eglin AFB, FL 32544 Location: 11 SOIS Hurlburt Field Eglin AFB, FL 32544 Location: 50 ATKS/482 ATKS (Shaw AFB) 31 Losano Road, Building 2007-4 Shaw AFB, SC 29152 Location: 6 RS, 9 ATKS, 29 ATKS (Holloman AFB) 1210 Forty Niner Road Holloman AFB, NM 88330 Location: 20 ATKS (Whiteman AFB) 920 12th Street, Bldg 53 Whiteman AFB, MO 65305 Location: 89 ATKS (Ellsworth AFB) 1432 Spaatz Dr., Bldg 1008 Ellsworth AFB, SD 57706 Location: 26 WPS (Nellis AFB) 3668 Tyndall Avenue, Bldg 215 Nellis AFB, NV 89191 Location: 432 OG/SSO (Creech AFB) Building 1016, Reaper Road Creech AFB, NV 89018 Location: 556 TEG (Creech AFB) Building 703, Perimeter Road Creech AFB, NV 89018 Block9: Sustainment of RPA-SOC mission systems, the operations and maintenance (O&M) of equipment, design/development, and installation of systems in support of Combat Air Patrols (CAP).

Provides Contractor Field Service Support to the Remotely Piloted Aircraft-Squadron Operations Centers (RPA-SOC). Maintains hardware and software that stores data up to and including the TS/SCI level. Performance occurs at various ANG sites throughout the continental U.S.

Provides continuity maintenance, support, repair, diagnostics and relevance of the Remote Piloted Aircraft (RPA) Operations Center (ROC) at Cannon AFB, NM and Hurlburt Field, FL.

The services under this contract for RPA SOC systems include (a) procurement of hardware, and software, (b) warehousing of Government procured material, (c) related engineering services, and (d) installation of the hardware and software at multiple CONUS locations.

Such information is not releasable to personnel holding only reciprocal clearances.

Ref 10 b &d: Access to Restricted/Formerly Restricted Data requires a final U.S. Government clearance at the appropriate level.

10e 1 &2: Contractor will require access to security directives specified in Attachment 1. Regulatory compliance is mandatory unless otherwise specified in writing by SSO ACC.

Ref 10f: The contractor must adhere to special access requirements procedures developed by the OPR. SAP performance at the contractor facility is not authorized. Performance will be limited to government approved facilities. See attachment 3 for additional SAP security requirements.

requirements.

Ref 10g: Special briefings are required for access to NATO IAW AFI 16-1404, Air Force Information Security Program. Prior approval of the contracting activity is required for subcontracting. Access to classified NATO information requires a final U.S. Government clearance at the appropriate level.

Ref 10i: ACCM: Contractors will require access to ACCM IVORY VALOR. The contractor must adhere to strict security requirements procedures developed by the ACCM OPR. ACCM performance at the contractor facility is not authorized. Performance will be limited to government approved facilities.

Ref 10k: For Official Use Only (FOUO) information provided under this contract shall be managed and safeguarded IAW DoD 5400.7-R, Chapter 4, DoD Freedom of Information Act (FOIA) Program. See Attachment 4. The government will provide classified/unclassified network access to include e-mail and web browser. Contractors will be held accountable for actions they initiate on the network and will conduct business IAW USAF, ACC and local base instructions and policies. Sponsoring government agency will provide Information Assurance training prior to contractor access to network services. JWICS: The government will only provide JWICS network access to include email and web access provided the contractor meets all SCI eligibility and training requirements and maintains the appropriate SCI access level. Contractors will be held strictly accountable for all actions they initiate on the network and will conduct business IAW USAF, ACC, and local base instructions and policies. JWICS privileges will be terminated if contractor does not maintain a current TS investigation.

Ref 11a: Contract performance is restricted to the locations identified in item 8a. The highest level of security clearance required for contract performance is Secret. Using activities will provide security classification guidance for performance of this contract. The government will oversee the handling and storage of classified information in support of this contract. The government will provide storage capability for all classified material required for this contract. All classified information shall be returned to the government upon termination of the contract.

Ref 11f: Contractor personnel will be assigned to Kadena AB, Japan; Ramstein AB, Germany and Sigonella AB, Italy and require access to classified information. Contractor personnel deployed to overseas locations may have access to classified information under the control of U.S. Military, Host Nation Military or Embassy personnel. The storage of classified information by contractor employees at any location abroad that is not under the U.S. Government control is prohibited.

Ref 11j: Contractor will follow base and unit Operations Security guidance (SOPs, OIs, etc.) for the locations identified in item 8a. A copy of local guidance will be provided to the contractor. AFCENT/FP.

300 Exploration Way Suite 430 Hampton, VA 23666