Attachment J-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PREVIOUS EDITION IS OBSOLETE.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

All classified visit requests by contractors shall be forwarded to the Contracting Officer Representative (COR) for approval and need -to-know certification before being sent to the facility to be visited.

All visit access requests (VARs) by contractors shall be sent via the Defense Information System for Security (DISS) to the DISA VAR Center (DISS SMO: DKABAA10) or appropriate SMO for the effort. The COR/ACOR must approve the VAR prior to sending the request to the facility being visited. Contractors must also provide a copy of the VAR to the SM.

The COR/ACOR must be notified and approve the receipt and/or generation of classified information under this contract.

All classified information received and/or generated under this contract is the property of the U.S. Government regardless of proprietary claims. Upon completion or termination of this contract, the U.S. Government will be contacted for destruction or disposition instructions.

Foreign Nationals will not perform on any area of the contract (classified or unclassified).

Prime Contractor FSO will provide the Government a copy of the subcontractor DD Form 254 and subcontract memo for all their subcontracts meeting review criteria via a SM to submit for approval.

Period of performance:

TBD

Reference Block 8a:

Current locations are:

COLUMBUS:

DISA Data Center Columbus, 3990 East Broad St., Bldg. 23, Columbus, OH 43213

FORT MEADE:

DISA Fort Meade, 6906 Cooper Avenue, Fort Meade, MD 20755

MECHANICSBURG:

DISA Data Center Mechanicsburg, Bldg. 308 North End, 5450 Carlisle Pike, Mechanicsburg, PA 17050-0975

MONTGOMERY:

DISA Data Center Montgomery, 401 East Moore Drive, Bldg. 857, Maxwell AFB/Gunter Annex, Montgomery, AL 36114-3001

OGDEN:

DISA Data Center Ogden, 7879 Wardleigh Road, Bldg. 891, Hill AFB, UT 84056-5996

OKLAHOMA CITY:

DISA Data Center Oklahoma City, Gate 33, SE59 and Air Depot Rd, 8705 Industrial Blvd., Bldg. 3900, Tinker AFB, Oklahoma City, OK 73145-3064

SAN ANTONIO:

DISA Data Center San Antonio, 3326 General Hudnell Dr, San Antonio, TX 78226-2023

ST LOUIS:

DISA Data Center St. Louis, Bldg. 103, 2nd Floor, Post D-2, 4300 Goodfellow Blvd., St. Louis, MO 63120-0012

Reference Block 10g: A NATO Secret briefing is required for SIPRNet access.

Reference Block 10j: Contractor will be provided with and will abide by DoDM 5400.07, DoD Freedom of Information Act Program, and DoDI 5200.48 Controlled Unclassified Information (CUI), Section 3.4. Guidance provided under separate cover.

Reference Block 10k: SIPRNet Access is required at the Government facility.

Reference Block 11a: Contract performance is restricted to government locations listed in block 8.a. The using contractor or Government facility will provide security classification guidance for the performance of this contract.

Reference Block 11e: Contract is for equipment maintenance services on equipment which processes classified information. Actual knowledge of, generation, or production of classified information is not required for performance of the contract. Cleared personnel are required to perform this service because access to classified information cannot be precluded by escorting personnel.

Bldg. 3600 2300 East Drive Scott Air Force Base, IL 62225-5406 Address: 1 Overcash Avenue, Bldg 12 Chambersburg, PA 17201