Attch 3 - DD Form 254 - ADEOC ARA Rev2 - Coord_signed.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PREVIOUS EDITION IS OBSOLETE.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)

Highest security classification varies per Call/Award contract. Overall, this effort requires a TS//SCI facility clearance and safeguarding capability. This DD Form 254 will be included as an attachment to the ARA solicitation; each subsequent Call/Award contract will have a DD Form 254 unique to that Call/Award and its unique security requirements.

Blk 12:

Ref Item 12: 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. Transmission of public release request via e-mail is not authorized.

Ref Item 10e(1): Public release of Sensitive Compartmented Information (SCI) is not authorized.

Blk 13:

Ref Item 1a/1b: Contractor must obtain a TOP SECRET Facility Security Clearance prior to being granted access to TOP SECRET information and must obtain TOP SECRET safeguarding capability for the authorizing official prior to being provided TOP SECRET information.

Ref Item 10a: Per Call/Award, the contractor is authorized to receive Government furnished cryptographic equipment. Access to classified COMSEC information requires a final U.S. Government clearance at the appropriate level. Further disclosure of COMSEC information by a contractor, to include subcontracting, requires prior approval of the GCA. Non-accountable COMSEC information, though not tracked in the COMSEC material control system, may still require a level of control within a document control system. Refer to NSA/CSS Manual 3-16, “Control of Communications Security Material,” and the Committee on National Security Systems Instruction (CNSSI) 4001, “Controlled Cryptographic Items,” for guidance. Contractor will comply with AFMAN 17-1302-O, Communications Security (COMSEC) Operations, 9 Apr 20. Contractor personnel will follow the security requirements of the host government activity.

Ref Item 10e(1): Contractor may require access to SCI materials (TBD per Call/Award); SCI security requirements apply, see 21 IS/INS, SSO WPAFB, SCI Addendum, for details.

Ref Item 10e(2): See AFMC Non-SCI addendum.

Ref Item 10g: A formal NATO briefing is required prior to granting access to NATO Secret information. See 32 CFR, Part 117, §117.19 (g) for details.

Ref Item 10g: Access to Joint Worldwide Intelligence Communications System (JWICS) is authorized (TBD per Call/Award). Users shall be briefed to NATO Secret IAW 32 CFR, Part 117, §117.19 (g) prior to access.

Ref Item 10j/11l: The contractor shall comply with DoDI 5200.48, Controlled Unclassified Information (CUI), Air Force Guidance Memorandum 2020-16-01, Air Force Guidance Memorandum for CUI, 23 Jul 20, 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 10k: Access to Secret Internet Protocol Router Network (SIPRNET) is authorized (TBD per Call/Award). SIPRNET users shall receive the Air Force North Atlantic Treaty Organization (NATO) Security Awareness Briefing and sign an acknowledgment prior to SIPRNET access. Actual knowledge of, generation, or production of NATO information is not required for performance on the contract.

Ref Item 10k: Prior to accessing military personally identifiable information, at a minimum, a favorably adjudicated Tier 1 background investigation is required IAW DoDM 5220.22V2_AFMAN 16-1406V2, Para 6.a(2)(a)1 (Added)(AF), National Industrial Security Program: Industrial Security Procedures for Government Activities.

Ref Item 11c. Any classified information generated in the performance of this contract shall require the contractor to apply derivative classification markings consistent with the source material.

Ref Item 11c: Contractor is authorized to have SIPRNET and JWICS connections at RHB, RHD or RHW location(s) in accordance with the contract package (TBD per Call/Award). Government approval authority is TBD per Call/Award.

Ref Item 11c: Contractor will reference the appropriate security classification guidance (to be provided in the contract package) when generating or deriving classified material or hardware. All classified information received or generated will be properly stored and handled according to the markings on the material. All classified information received or generated is the property of the U.S. Government. At the termination or expiration of the contract, the U.S. Government will be contacted to proper disposition instructions.

Ref Item 11k: Go to https://www.ustranscom.mil/cmd/associated/dcd/?page=FAQ.cfm for Defense Courier Service points of contact and guidance.

Ref Item 11m: Pre-contract award access to classified is not required.

Ref Item 11m: Provide the information requested by the Notification of Government Security Activity and Visitor Group Security Agreements clause, Air Force Federal Acquisition Regulation Supplement (AFFARS) 5352.204-9000, to the Information Protection Office for each installation applicable to the contract/award (to be provided in the contract package). The contractor shall comply with DoDM 5220.22 Vol 2_AFMAN 16-1406 Vol 2, National Industrial Security Program: Industrial Security Procedures for Government Activities, 8 May 20, 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).

Ref Item 11m: For some contracts (TBD per Call/Award), classified performance will occur on a U.S. Government installation for more than 90 consecutive days. For these contracts comply with AFFARS 5352.204-9000, Notification of Government Security Activity and Visitor Group Security Agreements. See Item 13.

Transfer of documents to other IR&D efforts is not permitted.

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.

IT Level II duties require a favorably completed National Agency Check Local Agency Check (NACLC) (Tier 3).

ADEOC ARA Program Manager: Mr. Dan Purdy, 711 HPW/RHB, 937-477-4277, danwin.purdy.2@us.af.mil

Security Manager: Ms. Tina Henry, 711 HPW/OMSI, 937-255-0805, tina.henry@us.af.mil.

Ref Item 18f (Distribution):

• 711 HPW/OMS, 2245 Monahan Way, Wright-Patterson AFB, OH 45433, 711HPW.OMS.Sec@us.af.mil

• Security Manager: Ms. Tina Henry, 711 HPW/OMSI, 2254 Monahan Way, WPAFB, OH 45433-7008, 937-255-0805, tina.henry@us.af.mil

• ADEOC ARA Program Manager: Mr. Dan Purdy, 711 HPW/RHB, 2729 Q Street, Bldg 837, Area B, WPAFB, OH 45433, 937-255-0443, danwin.purdy.2@us.af.mil

• Office symbol, (Contracting Officer’s Representative) street address, city state, zip code, e-mail address (TBD per Call/Award)

• WPAFB Special Security Office (SSO): 21 IS/INS, SSO WPAFB, 2450 D Street, Bldg 20, Area B, WPAFB OH 45433-7629, WPAFBSpecialSecurityOffice.Mailbox@us.af.mil

711 HPW/RHWL

rep: Mr. Eric C. Brown, SSO

21 IS/INS

rep: Mr. Anthony B. Jones, Branch Chief

711 HPW/OMSI

Ref Item 10k: Program Protection Plans (PPP) will be provided by the Government activity.

Ref Blk 11j: OPSEC requirements apply. See Statement of Objectives (SOO) for requirements.

Area B, Bldg 45, Rm 2303G Wright-Patterson AFB, OH 45433 Address: AFRL/RAKHA Area B, 2130 8th Street, Building 45, Room 2303G Wright-Patterson AFB, OH 45433