Attachment 4 - DD254 pdf.pdf

PDF 170 KB Posted Aug 17, 2026

Attached to: Electrical Equipment Operation and Maintenance Services Contract Electrical Maintenance Contract (EMC)
Solicitation number: FA239626RB004
Issued by: Department of the Air Force Materiel Command Research Laboratory

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PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, APR 2018

NEEDS DD67

(Updated 20250815)

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:

August 31, 2028 The public reporting burden for this collection of information, 0704-0567, is estimated to average 36 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 Form 254, "DoD Contract Security Classification Specification"

CurrentPage:

PageCount:

Classification (when form is filled in) (automatically filled from previous drop-down list): CUI

Serial Number:

1. CLEARANCE AND SAFEGUARDING - a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED

(See Instructions) - Select from drop-down list: 2

1. CLEARANCE AND SAFEGUARDING - b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/MATERIAL REQUIRED AT CONTRACTOR FACILITY - select from drop-down list: 4

3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "a. ORIGINAL (Complete date in all cases.) ": 0

3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "a. ORIGINAL (Complete date in all cases.) ": 1

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - a. PRIME CONTRACT NUMBER (See instructions.): Solicitation, Not Valid for Performance

3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "b. REVISED (Supersedes all previous specifications.)": 0

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - b. SUBCONTRACT NUMBER:

3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "c. FINAL (Complete Item 5 in all cases.)": 1

3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "c. FINAL (Complete Item 5 in all cases.)": 0

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER: FA2396-26-R-BXXX

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER - DUE DATE (YYYYMMDD):

3. THIS SPECIFICATION IS: (X and complete as applicable.) - a. ORIGINAL (Complete date in all cases.) : 20260603

3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - REVISION NUMBER:

3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - DATE (YYYYMMDD):

3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.):

3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.) - DATE (YYYYMMDD):

15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 0

15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 1

15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 0

15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 1

15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 0

15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 1

4. IS THIS A FOLLOW-ON CONTRACT? - If yes - Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract. - Enter preceding contract number.: FA8650-20-F-4099

5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of (period) - Enter contractor's request date in format YYYYMMDD.:

E5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of - Enter period.:

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. - a. TYPED NAME OF CERTIFYING OFFICIAL (Last, First, Middle Initial) (See Instructions): TBD

17. CERTIFICATION AND SIGNATURES - e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.): TBD

17. CERTIFICATION AND SIGNATURES - e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.): N/A

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): TBD

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): AFRL/RA

2130 8th Street, Area B Only

WPAFB, OH 45433

937-656-2779

8. ACTUAL PERFORMANCE (Click button to add more locations.) - Select to add row :

8. ACTUAL PERFORMANCE - Select to remove last row:

13. SECURITY GUIDANCE - Select to delete all signature rows:

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): AFRL/RA

2130 8th Street, Area B Only

WPAFB, OH 45433

Enter general unclassified description of this procurement.: Non-Personal commercial services - the contractor shall repair, maintain, and modify low, medium, and high voltage electrical research equipment at AFRL/RA on WPAFB. Contract name is High Voltage Research & Development (R&D) Electrical Maintenance Contract (EMC).

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 0

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 1

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 0

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 1

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "b. SUBCONTRACTOR.": 0

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.) - Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 1

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.) - Select for "h. REQUIRE A COMSEC ACCOUNT.": 0

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0

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.) - Select for "i. HAVE A TEMPEST REQUIREMENT.": 0

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: Select for "(1) Sensitive Compartmented Information (SCI).": 0

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: Select for "(2) Non-SCI.": 0

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.) - Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1

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.) - Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Enter specification for "other." (If more room is needed, continue in Item 13 or on additional page if necessary.): AFFARS 5352.204-9000 applies. See Blk 13.

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Enter specification for "other." (If more room is needed, continue in Item 13 or on additional page if necessary.):

Blk 18f: AFRL/RAYS, 2130 8th Street, WPAFB OH 45433, crystal.mcgaha@us.af.mil; christopher.hamilton.31@us.af.mil

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 1

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.) - Select for "l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI)." (DoD Components: refer to DoDI 5200.48, only for specific CUI protection requirements. Non-DoD Components: see instructions.): 1

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.) - Select for "m. OTHER.": 1

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) - Select for "DIRECT": 0

12. PUBLIC RELEASE - Select for "THROUGH": 1

12. PUBLIC RELEASE - Enter specification for "through".: AFRL/RA for non-SAR material. Transmission of public release request via e-mail is not authorized. Allow 15 days for processing.

12. PUBLIC RELEASE - Public Release Authority:: AFRL/RA

2130 8th Street, WPAFB OH 45433

13. SECURITY GUIDANCE - Select to add signature row:

13. SECURITY GUIDANCE - Select to remove last signature row:

Reviewing Official’s Office Symbol, phone and email (6): 32 Code of Federal Regulations, Part 117, National Industrial Security Program Operating Manual (NISPOM), 24 February 2021, applies.

The Contractor will notify the Government Contracting Activity and the Government Security Manager within 48 hours of any incident involving the actual or suspected compromise/loss of classified information to enable the Government to conduct immediate assessment of potential impact pending formal inquiry/investigation. Actual or suspected compromise of Covered Defense Information will be reported IAW DFARS Clause 252.204-7012.

SECURITY GUIDANCE:

Ref Blk 2c: Pre-contract award access to classified is not required.

Ref Item 10j/11l: The contractor shall comply with DoDI 5200.48, Controlled Unclassified Information (CUI), 5 October 2021, Air Force Guidance Memorandum for CUI, 26 November 2024, and DoDM 5400.7-Air Force Manual 33 302, DoD Freedom of Information Act (FOIA) Program. The contractor shall monitor CUI aggregation and compilation based on the potential to generate classified information pursuant to security classification guidance addressing the accumulation of unclassified data or information.

Ref Item 11a: The contractor will not generate classified information.

Ref Item 11m: Provide the information requested by the Notification of Government Security Activity and Visitor Group Agreements clause, Air Force Federal Acquisition Regulation Supplement (AFFARS) 5352.204-9000, to AFRL/RAYS the Servicing Security Activity (SSA), 2130 8th St, WPAFB, OH 45433, wright-pattersonAFRL/RQOS_all@us.af.mil. The contractor shall comply with DoDM 5220.32 Vol 1_AFMAN 16-1406 Vol 1, National Industrial Security Program: Industrial Security Procedures for Government Activities, 6 Mar 26, by following security procedures of the installation IAW para 3.8.a.; report adverse information IAW para 4.14 (Added)(AF); and support commander self-inspections and self-assessments IAW para 14.1.f (Added)(AF). See attached Security Agreement. See attached Security Agreement.

* AFRL/RA Security (RAYS) office must approve further disclosure of information covered under this effort, to include subcontracting.

* Upon the end of this effort, the contractor shall contact the AFRL/RAYS for disposition instructions of classified access or material generated or received during this effort.

* Any classified or covered defense information under this effort cannot be transferred or used for another effort to include IR&D, unless express written approval is received from AFRL/RA PM or AFRL/RAYS.

*Contractor personnel shall utilize US Government or official company email for transmitting official US Government business/information. US Government information shall NOT be transmitted via personal, private or commercial email or social media accounts (e.g. Hotmail, Gmail, Yahoo, Tik Tok, Facebook etc.). The use of DOD Safe is authorized for unclassified and Controlled Unclassified Information only.

*Contractor personnel are strictly prohibited from referencing this contract, classification, clearances, accesses (SAP/SAR, SCI), in advertisements, websites, capability fliers, promotional efforts or even in retirement notifications of employees.

Program Manager: Derek Longshore, AFRL/RA, derek.longshore.1@us.af.mil, 937-255-3589

Administrative Contracting Officer: TBD

Security Manager: Crystal McGaha, AFRL/RAYS, (937) 904-8609, crystal.mcgaha@us.af.mil; Christopher Hamilton, AFRL/RAYS, (937) 255-0562, christopher.hamilton.31@us.af.mil

Reviewing Official’s Office Symbol, phone and email (6): RAYS- Security Coordination

List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form) - Click on this button to attach a file(s).:

NAME & TITLE OF REVIEWING OFFICIAL (6): David Hanson

Chief of Security, AFRL/RAYS

17. CERTIFICATION AND SIGNATURES - h. SIGNATURE :

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.): Ref Blk 11j: OPSEC requirements apply. See Performance Work Statement (PWS) for requirements.

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.): Ref Blk 11m: Contractor performance will occur at WPAFB. DCSA is relieved of all inspection responsibilities for contractor performance on the installation. AFRL/RAYS will maintain security oversight.

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - a. GCA NAME: AFRL/RIZ

17. CERTIFICATION AND SIGNATURES - d. AAC OF THE CONTRACTING OFFICE (See Instructions): FA2396

17. CERTIFICATION AND SIGNATURES - c. ADDRESS (Include ZIP Code): AFRL/RIZ

1864 4th Street Wright-Patterson AFB, OH 45433

17. CERTIFICATION AND SIGNATURES - c. ADDRESS (Include ZIP Code): AFRL/RIZ 1864 4th Street Wright-Patterson AFB, Ohio 45433

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - d. POC NAME: Megan L Rosenbeck

17. CERTIFICATION AND SIGNATURES - f. TELEPHONE (Include Area Code): 3856355710

17. CERTIFICATION AND SIGNATURES - g. EMAIL ADDRESS (See Instructions): megan.rosenbeck@us.af.mil

17. CERTIFICATION AND SIGNATURES - b. TITLE : Contracting Officer

17. CERTIFICATION AND SIGNATURES - i. DATE SIGNED (See Instructions): 20260612

File details come from the government source that posted it. Updated Aug 17, 2026.