Attachment 9_DD254.pdf

CLASSIFICATION (When filled in): Unclassified

PREVIOUS EDITION IS OBSOLETE. Page 1 of 4DD FORM 254, APR 2018

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

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED

(See Instructions)

Secret

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

None (See instructions)

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.)

a. PRIME CONTRACT NUMBER (See instructions.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

FA8201-21-R-0018

DUE DATE (YYYYMMDD)

3. THIS SPECIFICATION IS: (X and complete as applicable.)

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20210611

b. REVISED (Supersedes all previous specifications.)

REVISION NO. DATE (YYYYMMDD)

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

4. IS THIS A FOLLOW-ON CONTRACT? No Yes If yes, complete the following:

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

5. IS THIS A FINAL DD FORM 254? No Yes If yes, complete the following:

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

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

a. NAME, ADDRESS, AND ZIP CODE

TBD

b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

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) Add Row Remove Last Row Delete All Rows

a. NAME, ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

8. ACTUAL PERFORMANCE (Click button to add more locations.) Add Row Remove Last Row Delete All Rows

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

75 ABW/SC

6068 Aspen Ave, BLDG 1294 Hill AFB, UT 84056

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

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional) See Item 15, Ref 8.a

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

HAFB has a current services contract, expiring in September 2021, to support and maintain all Tier 1 and Tier 2 VTCs and A/V equipment located at Hill Air Force Base. After evaluation, we have determined there is an on-going need to provide support for existing systems but will need a comprehensive means to address the aging equipment through technical refresh.

This is an IDIQ contract to provide services to design, purchase, refresh, troubleshoot, and maintain VTCs and will be available to any organization on HAFB. CLINs will include: Design/Engineering, Installation, Maintenance, and Informational Maintenance of New and Upgraded VTC Equipment, and Maintenance for cybersecurity compliance, usability, and availability.

PREVIOUS EDITION IS OBSOLETE. Page 2 of 4DD FORM 254, APR 2018

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 f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

b. RESTRICTED DATA g. NORTH ATLANTIC TREATY ORGANIZATION

(NATO) INFORMATION

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

d. FORMERLY RESTRICTED DATA i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

e. NATIONAL INTELLIGENCE INFORMATION:

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

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

k. OTHER (Specify) (See instructions.)

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.)

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE, STORE, AND GENERATE CLASSIFIED

INFORMATION OR MATERIAL

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE

e. PERFORM SERVICES ONLY

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

h. REQUIRE A COMSEC ACCOUNT

i. HAVE A TEMPEST REQUIREMENT

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE

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.)

m. OTHER (Specify) (See instructions.)

The AFFARS clause 5352.204-9000 applies

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 THROUGH (Specify below)

75 ABW Public Affairs Office, 7981 Georgia Street, Hill AFB, UT 84056 (801-777-5201)

Public Release Authority:

AFIMSC, Public Affairs (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330- 1690

13. SECURITY GUIDANCE Add Signature Remove Last Signature Delete All Signatures

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.)

Ref. 10.j.: CUI information provided under this contract shall be safeguarded as specified in DOD Instruction 5200.48, Controlled Unclassified Information (CUI).

Ref. 11.a.: Contract performance is restricted to locations identified in Items 8.a. Security classification guidance has been provided and is available at this location for performance on the contract.

Ref. 11.e: Contract is for IT services on equipment which processes classified information. Actual knowledge, generation, or production of classified information is not required for performance of the contract. Cleared personnel are required to perform this service because visual or aural access to classified information cannot be precluded by escorting personnel. Any classification guidance will be provided by the using activity.

Ref 11.m. The contractor is designated as an Integrated Visitor Group and will provide the Servicing Security Activity, listed in Item 15 “Ref: 8.a”, with all the information required by the Air Force Federal Acquisition Regulation Supplement (AFFARS) 5352.204-9000, PREVIOUS EDITION IS OBSOLETE. Page 3 of 4DD FORM 254, APR 2018

Notification of Government Security Activity and Visitor Group Security Agreements clause at least 30 days prior to beginning operations on Hill AFB. Contractors will not begin operations on Hill AFB until a Visitor Group Security Agreement has been signed.

3.a Project Manager: Kelly Yocum, 75 ABW/SCXP, 777-9318

13.b DD FM 254 Review Date: 09/17/2023

THE PRIME CONTRACTOR SECURITY OFFICE CAN BE REACHED VIA E-MAI L ADDRESS: SECURITY@FCNIT.COM

List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form) Hide Attachment Bar

NAME & TITLE OF REVIEWING OFFICIAL

Stephanie Hamby, GS11, DAF Security Manager

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL

Zachary Aguiar, 75 ABW/SCXP, Program Manager

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL

Steven G. Nutt, 75 ABW/IPD, Industrial Security Specialist

SIGNATURE

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, are established for this contract.

No Yes 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.)

Ref 11.j. The contractor must comply with the U.S. Government, DOD, Air Force, AFMC, Hill AFB, and 75 ABW/SC Operation Security (OPSEC) Programs. The contractor must comply with any additional OPSEC requirements referenced in the Performance Work Statement, Section 3.15.

15. INSPECTIONS

Elements of this contract are outside the inspection responsibility of the CSO.

No Yes 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. 8.a.: The Defense Counterintelligence and Security Agency (DCSA) is relieved of all industrial security review responsibilities for contractor performance on the government installation identified in Item 8.a. The SSA, 75 ABW/IPD 7981 Georgia Street, HAFB, UT 84056 (lashonda.arocha.2@us.af.mil) has exclusive oversight responsibilities while operating on the installation.

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

a. GCA NAME

AFSC OL:H/PZIOA

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

FA8201

c. ADDRESS (Include ZIP Code) 6038 Aspen Avenue, Bldg 1289NE Hill Air Force Base, UT 84056

d. POC NAME

Daniel C. Brock

e. POC TELEPHONE (Include Area Code)

+1 (801) 775-5306

f. EMAIL ADDRESS (See Instructions) daniel.brock.5@us.af.mil

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)

PREVIOUS EDITION IS OBSOLETE. Page 4 of 4DD FORM 254, APR 2018

b. TITLE

c. ADDRESS (Include ZIP Code)

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

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

f. TELEPHONE (Include Area Code)

g. EMAIL ADDRESS (See Instructions)

h. SIGNATURE

i. DATE SIGNED (See Instructions)

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

a. CONTRACTOR

b. SUBCONTRACTOR

c. COGNIZANT SECURITY OFFICE FOR PRIME AND

SUBCONTRACTOR

d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY

ADMINISTRATION

e. ADMINISTRATIVE CONTRACTING OFFICER

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

lashonda.arocha.2@us.af.mil

Ref Item 11.j. OPSEC requirements are as follows:

Reference: National Security Decision Directive (NSDD) 298

DOD 5205.02

DODD 5205.02E

AFI10-701AFGM_2018-01

All contractors, subcontractors, their employees, associates, and consultants who have access to critical information must comply with the DOD and Air Force-sponsored Operations Security (OPSEC) program. The OPSEC Program is directed by NSDD298, DOD Publications, and applicable Air Force guidance.

OPSEC is a systematic means of identifying and protecting information, which an adversary could use to their advantage or to our disadvantage. Critical Information (CI) is generally unclassified but can become classified through compilation. This sensitive information has been identified by the organization’s OPSEC program as requiring protection. OPSEC Measures (OM) are control standards with which all personnel must comply in order to protect CI against adversaries.

RESPONSIBILITIES:

The 75 ABW/SC OPSEC Program Coordinator Stephanie Hamby will provide / approve OPSEC training curriculum for use by the contractor. Critical Information and Indicator Listings (CIILs) will be protected by all contract personnel. Approved organizational OPSEC measures will be used by all contract personnel to protect critical information in their possession and protect against current foreign intelligence and industrial espionage threats. The OPSEC PM/Coordinator and the Lead contractor must ensure all contract personnel working on the contract or having access to CI attend initial and annually recurring refresher training and that the approved curriculum is presented.

Training will be provided before contract personnel are allowed access to or handling of critical information. All contract personnel will comply with the organizations OPSEC standards and practices as trained. Additional training may be required based on updates to critical information, OPSEC measures, intelligence threat/vulnerability, or other fundamental changes to the OPSEC program. The OPSEC Coordinator is responsible for contacting the OPSEC Program Manager if OPSEC isn’t written into the contract.

The OPSEC PM/Coordinator for the organization will track OPSEC training statistics for all personnel working on the contract, when each individual has received the required OPSEC training, and when refresher training is due. Forward training statistics to the installation OPSEC PM at the end of each calendar quarter and/or upon request. The OPSEC Coordinator will provide a copy of the 75 ABW OPSEC Plan to the contractor upon request and the contractor is subject to the requirements of that plan. The 75 ABW OPSEC Plan is “for official use only” and distribution outside the constraints of the contract in part or in its entirety is prohibited. Upon completion of the contract, the contractor will destroy the OPSEC Plan by shredding the document so that it cannot be reconstructed and deleting any electronic copies.

Contactors with OPSEC requirements within a contract must ensure employees receive OPSEC training as specified within the contract. Accomplishment of training must not exceed 90 days from initial assignment to a contract with OPSEC requirements. Annual training will be accomplished NLT 30 September of each year. The contractor personnel will not be given access to an organization’s CIIL until after training has been completed and documented by the organization OPSEC Coordinator.

Prior to seeking approval through Hill AFB Public Affairs, any information to be released outside of official U.S. Government channels, via any media, must be approved through an OPSEC review by the 75 ABW/SC PM/Coordinator. All personnel must promptly report OPSEC related incidents, issues, and concerns to the 75 ABW/SC PM/Coordinator, 801-586-0332 who will then report it to the installation PM, 801-586-8008.

DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of

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" Hide Attachment Bar

6068 Aspen Ave, BLDG 1294 Hill AFB, UT 84056 Enter general unclassified description of this procurement.: HAFB has a current services contract, expiring in September 2021, to support and maintain all Tier 1 and Tier 2 VTCs and A/V equipment located at Hill Air Force Base. After evaluation, we have determined there is an on-going need to provide support for existing systems but will need a comprehensive means to address the aging equipment through technical refresh.

This is an IDIQ contract to provide services to design, purchase, refresh, troubleshoot, and maintain VTCs and will be available to any organization on HAFB. CLINs will include: Design/Engineering, Installation, Maintenance, and Informational Maintenance of New and Upgraded VTC Equipment, and Maintenance for cybersecurity compliance, usability, and availability.

Ref. 11.a.: Contract performance is restricted to locations identified in Items 8.a. Security classification guidance has been provided and is available at this location for performance on the contract.

Ref. 11.e: Contract is for IT services on equipment which processes classified information. Actual knowledge, generation, or production of classified information is not required for performance of the contract. Cleared personnel are required to perform this service because visual or aural access to classified information cannot be precluded by escorting personnel. Any classification guidance will be provided by the using activity.

Ref 11.m. The contractor is designated as an Integrated Visitor Group and will provide the Servicing Security Activity, listed in Item 15 “Ref: 8.a”, with all the information required by the Air Force Federal Acquisition Regulation Supplement (AFFARS) 5352.204-9000, Notification of Government Security Activity and Visitor Group Security Agreements clause at least 30 days prior to beginning operations on Hill AFB. Contractors will not begin operations on Hill AFB until a Visitor Group Security Agreement has been signed.

3.a Project Manager: Kelly Yocum, 75 ABW/SCXP, 777-9318

13.b DD FM 254 Review Date: 09/17/2023

THE PRIME CONTRACTOR SECURITY OFFICE CAN BE REACHED VIA E-MAI L ADDRESS: SECURITY@FCNIT.COM

Security Manager

Hill Air Force Base, UT 84056