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PREVIOUS EDITION IS OBSOLETE.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:

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

202 East Drinker Street Dunmore, PA 18512

2 International Plaza Suite 340 Philadelphia, PA 19113 dcsa.dcsa-northern.dcsa-isfo.mbx.philadelphia-field-office@mail.mil / phone 610-537-1060

6066 Cedar Lane, Bldg 1274 Hill AFB UT 84056 Location: 309th Software Integration Lab, 6137 Wardleigh Road, Bldg 1515 Hill AFB UT 84056 Location: Eglin AFB, FL 32542 Barksdale AFB, LA 71110 Ellsworth AFB, SD 57706 Edwards AFB, CA 93524 Location: Tyndall AFB, FL 32403 Tinker AFB, OK 73145 Nellis AFB, NV 89191 Naval Air Weapons Station, China Lake, CA 93555

75 ABW/PA,

7285 4th Street, Hill AFB, UT. 84056 (801-777-5201)

75 ABW/IPD

AFLCMC IP 1801 Tenth St, Bldg 8, Room 103, WPAFB, OH 45433-7629, AFLCMC.IPDDForm254.Workflow@us.af.mil

Hill AFB, UT 84056 (801-777-5201)

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.

Program Manager, Contracting Officer’s Representative: Curtis Goodrich, AFLCMC/EBHC, ph: 801-775-6099, curtis.goodrich@us.af.mil

Security Manager: Andrea Slaga, AFLCMC/EBH, ph: 801-777-8973, andrea.slaga.2@us.af.mil

Ref Blk 1a: Contractor must be granted a SECRET Facility Security Clearance prior to being granted access to SECRET information.

Ref Blk 10j\11l: The contractor shall comply with DoDI 5200.48_DAFI16-1403, Controlled Unclassified Information, DoDM 5200.01, Vol 1_AFMAN16-1404, Vol 1, Air Force Information Security Program, and DoDM 5400.07_AFMAN33-302 Air Force Manual, 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 Blk 11a:Contract performance is restricted to location identified in Item 8.a. - 8.c. Contractor requires access to classified areas but all material they will handle and produce will be unclassified. If required the applicable SCG for this program is CBU-WCMD Security Classification Guide (SCG) dated 2018 09 13. ( OPR: AFLCMC EBH, Munitions Sustainment Division, Hill AFB, UT). SCG will be provided under separate cover.

Ref Blk 11e:Contract is for engineering services. Classification markings on the material to be furnished will provide the guidance necessary for performance of the contract.

Ref Blk 11j:The contractor must comply with the U.S. Government, DOD, Air Force, AFMC, Hill AFB, and (AFLCMC/EBH) Operation Security (OPSEC) Programs. The contractor must also comply with any additional OPSEC requirements referenced in the PWS.

Ref Blk 11l:The Following FARS and DFARS Clauses apply: FAR Clause 52.204-2, FAR Clause 52.204-21, DFARS 252.204-7000, DFARS 252.204-7008, DFARS 252.204.7009, DFARS Clause 252.204-7012, and DFARS Clause 252.239-7010.

Ref Blk 11m: Any transfer or processing of sensitive information via electronic methods (e.g. facsimile, telemetry, voice, computer) must be protected by implementing an appropriate combination of countermeasures such as encryption devices and sound practices and procedures. Specific countermeasures used must be coordinated by the project manager for approval through the appropriate communications activity. The contractor is designated as a Intermittent contractor and will request installation specific security policies from the Servicing Security Activities listed in Item 15 “Ref: 8.a” prior to beginning operations.

Ref Blk 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.

Ref Blk 18f (Distribution):

AFLCMC IP 1801 Tenth St, Bldg 8, Room 103, WPAFB, OH 45433-7629, AFLCMC.IPDDForm254.Workflow@us.af.mil AFLCMC/EBHC, Lead Engineer, 6043 Elm Lane, Hill AFB, UT 84056, Curtis Goodrich, curtis.goodrich@us.af.mil AFLCMC/EBH, Security Manager, 6043 Elm Lane, Bldg 1246, Hill AFB, UT 84056, AFLCMC.EBH.Security@us.af.mil HQ Defense Counterintelligence and Security Agency, 27130 Telegraph Rd, Quantico, VA 22134

AFLCMC/EBHC LEAD ENGINEER

rep: ANDREA L. SLAGA, NH-03

AFLCMC/EBH SECURITY MANAGER

rep: SEAN D. CRONE, NH-04 AFLCMC IP

INDUSTRIAL SECURITY LEAD

Ref 11j: Operations Security (OPSEC): The contractor shall ensure OPSEC is incorporated into the appropriate area of the contract IAW DoD Directive 5205.02E, DoD Operations Security (OPSEC) Program and AFI 10-701 Air Force OPSEC Program. The Contractor shall flow down all OPSEC requirements to subcontractors that handle Critical Information (CI). CI is defined as specific facts about friendly intentions, capabilities, or activities needed by adversaries to plan and act effectively against friendly mission accomplishment. The contractor must comply with the U.S. Government, DOD, Air Force, AFMC, Hill AFB, and (AFLCMC/EBH) Operation Security (OPSEC) Programs. The contractor must also comply with any additional OPSEC requirements referenced in the PWS.

6072 Fir Ave, Bldg 1233 Hill AFB, UT 84056 Address: 6072 Fir Avenue Building 1233 Hill AFB, Utah 84056