DD254.pdf

CLASSIFICATION (When filled in): Unclassified

PREVIOUS EDITION IS OBSOLETE. Page 1 of 4DD FORM 254, MAY 2019 PREVIOUS EDITION IS OBSOLETE. Page 1 of 4DD FORM 254, MAY 2019

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:

20220531

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

Secret

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

a. PRIME CONTRACT NUMBER (See instructions.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

FD2020-21-00604

DUE DATE (YYYYMMDD)

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

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20210315

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

TBD

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

TBD

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

TBD

b. CAGE CODE

TBD

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

TBD

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.)

TBD

b. CAGE CODE

(If applicable, see Instructions.)

TBD

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

TBD

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

This contract covers spares procurement of FET AMP, used in the MLPRF of the APG-68 Radar system in the F16 C/D aircraft. Testing of this item requires test parameter data contained in Secret documents.

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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 DoDM 5200.01, Volume 4 only for specific CUI protection requirements. Non-DoD Components: see instructions.)

m. OTHER (Specify) (See 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)

DIRECT THROUGH (Specify below)

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

Public Release Authority:

SAF, Public Affairs (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330-1690 (703) 571-5370

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 Manual 5200.01, Volume 4, DoD Information Security Program: Controlled Unclassified Information (CUI).

Ref 11.b.: The contractor requires access to classified source data up to and including SECRET in support of the work effort. All classified information received or generated will be properly stored and handled according to the markings on the material. Contractor will abide by the following security classification guidance: F-16 MULTIMISSION FIGHTER SECURITY CLASSIFICATION GUIDE, revised 2 March 2016. The applicable SCG will be provided under a separate cover. At the termination or expiration of this contract, the U.S.

Government will be contacted for proper disposition instructions.”

Ref 11.l. In accordance with DFARS Subpart 252.204-7012, contractors and subcontractors will safeguard covered defense information that resides in or transits through contractor information systems by applying specified network security controls, and will report cyber incidents. Contractors are prohibited from releasing unclassified information to the public without approval of the contracting activity.

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List of Attachments [1] (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form)

Add Attachment View Selected Attachment Remove Selected Attachment

416 SCMS Government Program Engineer Joe Refahiyat, NH-03, DAF

(801) 775-4602

NAME & TITLE OF REVIEWING OFFICIAL

Joe Refahiyat, 416 SCMS/GUEAA

Program Engineer

SIGNATURE

448 SCMW Security Manager Michael J. Mazoyer, GS-12, DAF (801)777-4074

NAME & TITLE OF REVIEWING OFFICIAL

Michael Mazoyer, 448 SCMW/OMO-Hill Security Manager

SIGNATURE

75 ABW/IPD

LaShonda R. Arocha, NH-03, DAF (801)777-5490

NAME & TITLE OF REVIEWING OFFICIAL

LaShonda R. Arocha, NH-03, DAF 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 448 SCMW Operation Security (OPSEC) Programs. The contractor must comply with any additional OPSEC requirements referenced.

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.)

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

a. GCA NAME

AFMC/OL:H/PZABA

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

FA8212

c. ADDRESS (Include ZIP Code) 6050 Gum Lane Bldg 1215 Hill AFB, UT 84056

d. POC NAME

Patrick Jurkiewicz

e. POC TELEPHONE (Include Area Code)

+1 (801) 775-6365

f. EMAIL ADDRESS (See Instructions) patrick.jurkiewicz@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)

Jurkiewiez, Patrick

b. TITLE

Contracting Officer

c. ADDRESS (Include ZIP Code) 6050 Gum Lane Bldg 1215 Hill AFB, UT 84056

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

FA8212

e. CAGE CODE OF THE PRIME CONTRACTOR

(See Instructions.)

N/A

f. TELEPHONE (Include Area Code)

+1 (801) 775-6365

g. EMAIL ADDRESS (See Instructions) patrick.jurkiewicz@us.af.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

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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.)

1. 75 ABW/IPD (lashonda.arocha.2@us.af.mil)

2. 448 SCMW/OMO (michael.mazoyer.1@us.af.mil)

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

Prime Solicitation #: FD2020-21-00604

References:

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 748 SCMG Security Manager, Michael Mazoyer or the 748 SCMG OPSEC Program Manager (PM) Paul Baldwin, will provide OPSEC training curriculum for use by the contractor. Critical Information and Indicator Listings (CIILs) must be protected by all contract personnel. Approved organizational OPSEC measures must be used by all contract personnel to protect critical information in their possession and protect against current foreign intelligence and industrial espionage threats.

The 748 SCMG Security Manager or the 748 SCMG OPSEC PM 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 must be provided before contract personnel are allowed access to or handling of critical information. All contract personnel will comply with the 748 SCMG 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 748 SCMG Security Manager the 748 SCMG OPSEC PM and the Government Program manager 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 748 SCMG Security Manager or the 748 SCMG OPSEC PM will provide a copy of the 748 SCMG OPSEC Plan to the contractor upon request and the contractor is subject to the requirements of that plan. The 748 SCMG 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 organizations CIIL until after training has been completed and documented by the 748 SCMG Security Manager.

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 748 SCMG Security Manager or the 748 SCMG OPSEC PM.

All personnel must promptly report OPSEC related incidents, issues, and concerns to:

748 SCMG Security manager, Michael J. Mazoyer, (801)777-4074, michael.mazoyer.1@us.af.mil or 748 SCMG OPSEC Program Manager, Paul Baldwin, (801)586-5712, paul.baldwin.3@us.af.mil

Who will then report it to the installation PM (801)586-5712.

mailto:michael.mazoyer.1@us.af.mil mailto:paul.baldwin.3@us.af.mil

DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, MAY 2019

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:

20220531 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 whs.mc-alex.esd.mbx.formswebmaster@mail.mil

WHS

List of Attachments [1] (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form) FD2020-21-00604 OPSEC ADDENDUM.pdf

2. 448 SCMW/OMO (michael.mazoyer.1@us.af.mil)

Ref 11.b.: The contractor requires access to classified source data up to and including SECRET in support of the work effort. All classified information received or generated will be properly stored and handled according to the markings on the material. Contractor will abide by the following security classification guidance: F-16 MULTIMISSION FIGHTER SECURITY CLASSIFICATION GUIDE, revised 2 March 2016. The applicable SCG will be provided under a separate cover. At the termination or expiration of this contract, the U.S. Government will be contacted for proper disposition instructions.”

Ref 11.l. In accordance with DFARS Subpart 252.204-7012, contractors and subcontractors will safeguard covered defense information that resides in or transits through contractor information systems by applying specified network security controls, and will report cyber incidents. Contractors are prohibited from releasing unclassified information to the public without approval of the contracting activity.

text: 416 SCMS Government Program Engineer Joe Refahiyat, NH-03, DAF

(801) 775-4602 text: 448 SCMW Security Manager Michael J. Mazoyer, GS-12, DAF (801)777-4074 text: 75 ABW/IPD LaShonda R. Arocha, NH-03, DAF (801)777-5490

Program Engineer rep: Michael Mazoyer, 448 SCMW/OMO-Hill Security Manager rep: LaShonda R. Arocha, NH-03, DAF Industrial Security Specialist

Bldg 1215 Hill AFB, UT 84056 Address: 6050 Gum Lane Bldg 1215 Hill AFB, UT 84056