draft DD 254 - RPATS FY23.pdf
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- Solicitation number
- FA480122R0001
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ATTACHMENT #1
DD FORM 254 CONTINUATION SHEET
Ref 12: Information requiring AF or DOD-level review will be forwarded by the entry-level public affairs office (49 WG/PA) through the MAJCOM/DRU 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. Public release of classified information not authorized.
Ref 14: Visitor Groups will safeguard all collateral classified information IAW DODM 5200.01, V3, Protection of Classified Information; AFMAN 16-1404, Air Force Information Security
Program; AFMAN 16-1406, Air Force Industrial Security Program, and other directives deemed necessary by the servicing IPO. Prior approval of the contracting activity is required for subcontracting.
Ref 17f: 49 WG/IP, 490 First Street, Bldg 29, Suite 2560, Holloman AF
ATTACHMENT #2
DD FORM 254, FOR OFFICIAL USE ONLY (FOUO) ADDENDUM
CONTROLLED UNCLASSIFIED INFORMATION (CUI) ADDENDUM
Executive Order 13526 has specified certain types of unclassified information require application of access, distribution controls, and protective measures for a variety of reasons. This information is referred to collectively as CUI.
CUI is identified as one of the following categories:
• Official Use Only (FOUO)
• Law Enforcement Sensitive (LES)
• DoD Unclassified Controlled Nuclear Information (DoD UCNI)
• Limited Distribution
• Department of State (DoS) Sensitive But Unclassified (SBU) Information
• Drug Enforcement Administration (DEA) Sensitive Information
• Foreign Government Information
• Distribution Statements On Technical Documents
For the purpose of this addendum, we will identify controls and protective measures for FOUO.
Therefore, when CUI other than FOUO is to be provided to or generated by DoD contractors, the controls and protective measures to be applied shall be described in the pertinent contract documents (e.g., contract clause and/or statement of work).
FOUO Markings and Protection. It is the responsibility of the document’s originator to determine at origination whether the information may qualify for FOUO status and to ensure markings are applied as required.
Markings:
• Documents shall be marked “FOR OFFICIAL USE ONLY” at the bottom of the outside of the front cover (if there is one), the title page, the first page, and the outside of the back cover (if there is one).
• Internal pages of the document that contain FOUO information shall be marked “FOR
OFFICIAL USE ONLY” at the bottom. Optionally, for consistency with classified systems, internal pages may be marked “UNCLASSIFIED//FOR OFFICIAL USE ONLY” or
“UNCLASSIFIED//FOUO”; in such case internal pages shall be marked at both the top and bottom.
• Subjects, titles, and each section, part, paragraph, or similar portion of an FOUO document shall be marked to show that they contain information requiring protection. Use the parenthetical notation “(FOUO)”
• Each part of electronically transmitted messages, including e-mail, containing FOUO information shall be marked as required by paragraph 2.c of this enclosure. Unclassified messages containing FOUO information shall be marked “FOR OFFICIAL USE ONLY”
• After working hours, FOUO information may be stored in unlocked containers, desks, or cabinets if Government or Government-contract building security is provided. If such building security is not provided or is deemed inadequate, the information shall be stored in locked desks, file cabinets, bookcases, locked rooms, etc.
• Transmittal documents that have FOUO attachments, but no classified material attached, shall be marked with the following statement or a similar one: “FOR OFFICIAL USE ONLY
ATTACHMENT.”
• Computer files and other electronic media, audiovisual media, chart, maps, films, sound recordings, etc., which contain FOUO will be
Protection of FOUO Information:
• During duty hours, contractors will take reasonable steps to minimize the risk of access by unauthorized personnel
• After working hours, FOUO information may be stored in unlocked containers, desks, or cabinets if Government or Government-contract building security is provided. If such building security is not provided or is deemed inadequate, the information shall be stored in locked desks, file cabinets, bookcases, locked rooms, etc.
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
| CurrentPage: |
| PageCount: |
| Select classification from drop-down list.: Unclassified |
| SerialNum: |
| a. Facility clearance level. Select one.: 2 |
| b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 4 |
| Select for "original.": 0 |
| Select for "original.": 1 |
| Enter prime contract number.: |
| Select for "revised.": 0 |
| Select for "revised.": 0 |
| Enter subcontract number.: |
| Select for "final.": 1 |
| Select for "final.": 0 |
| Enter solicitation or other number.: FA480122R0001 |
| Enter due date in format YYYYMMDD.: |
| Enter date in format YYYYMMDD.: 20220308 |
| Enter revision number.: |
| Enter date in format YYYYMMDD.: |
| Enter final specification.: |
| Enter date in format YYYYMMDD.: |
| Select for "no.": 0 |
| Select for "no.": 1 |
| Select for "no.": 0 |
| Select for "no.": 1 |
| Select for "yes.": 1 |
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| Select for "yes.": 1 |
| Select for "yes.": 0 |
| Enter preceding contract number.: |
| Enter contractor's request date in format YYYYMMDD.: |
| Enter period.: |
| Enter typed name of certifying official (last, first, middle initial).: TBD |
| Enter typed name of certifying official (last, first, middle initial).: N/A |
| Enter typed name of certifying official (last, first, middle initial).: Sally D. Roberts |
| Enter CAGE code of the prime contractor.: TBD |
| Enter CAGE code of the prime contractor.: N/A |
| Enter CAGE code of the prime contractor.: N/A |
| Enter CAGE code of the prime contractor.: N/A |
| Enter CAGE code of the prime contractor.: N/A |
| Enter CAGE code of the prime contractor.: N/A |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: TBD |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: N/A |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: N/A |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: N/A |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: N/A |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: N/A |
| Select to add row to locations.: |
| Select to remove last row from locations.: |
| Select to delete all signatures.: |
| Enter location(s).: |
16 TRS
897 W. Sixth St, Bldg 513 Holloman AFB, NM 88330 575-572-4735 Enter location(s).:
49 OG
724 Delaware, Bldg 317 Holloman AFB, NM 88330 575-572-1140 Enter location(s).:
6 ATKS
1022 Fifth St, Bldg 302 Holloman AFB, NM 88330 575-572-6970 Enter location(s).:
9 ATKS/29 ATKS
1021 Fifth St, Bldg 318 Holloman AFB, NM 88330 575-572-5344/1055
| Enter general unclassified description of this procurement.: Provide Remotely Piloted Aircraft Training Support. The services include Simulated Mission Operators, Simulator Tactical Programmers, Integrated Mission Developers, Simulator Duty Directors, and Administrative Support. All positions, other than administrative support, assist by providing injects into scenarios or controlling the scenarios used during the simulation or actual flight operations. |
| Select for "a. CONTRACTOR.": 0 |
| Select for "a. CONTRACTOR.": 1 |
| Select for "a. CONTRACTOR.": 1 |
| Select for "f. OTHER AS NECESSARY.": 0 |
| Select for "f. OTHER AS NECESSARY.": 0 |
| Select for "f. OTHER AS NECESSARY.": 1 |
| Select for "b. SUBCONTRACTOR.": 0 |
| Select for "b. SUBCONTRACTOR.": 0 |
| Select for "b. SUBCONTRACTOR.": 0 |
| Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0 |
| Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0 |
| Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0 |
| Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0 |
| Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0 |
| Select for "h. REQUIRE A COMSEC ACCOUNT.": 0 |
| Select for "h. REQUIRE A COMSEC ACCOUNT.": 0 |
| Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0 |
| Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0 |
| Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0 |
| Select for "i. HAVE A TEMPEST REQUIREMENT.": 0 |
| Select for "i. HAVE A TEMPEST REQUIREMENT.": 0 |
| Select for "e. NATIONAL INTELLIGENCE INFORMATION: - (1) Sensitive Compartmented Information (SCI).": 0 |
| Select for "e. NATIONAL INTELLIGENCE INFORMATION: - (2) Non-SCI.": 0 |
| Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1 |
| Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 0 |
| Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 1 |
| Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0 |
| Enter infomration for "other.": SIPRNET |
| Enter infomration for "other.": 49 WG/IP marilyn.darby@us.af.mil |
49 OG/DD COR daniel.cass@us.af.mil
| Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0 |
| Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 1 |
| Select for "l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI). .": 1 |
| Select for "m.OTHER.": 0 |
| Select for "direct.": 0 |
| Select for ": 1 |
| Enter specification for "through".: 49 WG/PA |
HQ AETC/PA
Enter public release authority.: 49WG.PAOffice@us.af.mil AETC.PAInbox@us.af.mil
| Select to add signature.: |
| Select to remove last signature.: |
| text: Contract Period of Performance: 1 July 2023 - 30 June 2024 w/four 1-year options. COR is Mr. Daniel Cass, DAF, 49 OG/DD |
Ref 10j: Controlled Unclassified Information (CUI) See Addendum at Attachment #2.
Ref 10k: The Government will provide classified network access to include e-mail and web browser. Contractors will be held accountable for actions they initiate on the network and will conduct business IAW USAF, AETC, and local base instructions and policies. Sponsoring government agency will provide Information Assurance training prior to contractor access to network services.
Ref 11a. Contract performance is restricted to the location identified in item 8a. The highest level of security clearance required for contract performance is Secret. Using activities will provide security classification guidance for performance of this contract. The Government will oversee the handling and storage of classified information in support of this contract. The Government will provide storage capability for all classified material required for this contract. All classified information shall be returned to the Government upon termination of the contract.
| Click on this button to attach a file(s).: |
| rep: Marilyn Darby, DAFC (575) 572-1017 |
Prgm Mgr, 49 WG/IP
| Enter signature.: |
| Explain and identify specific areas and government activity responsible for inspections.: Visitor Group contractors are required to enter into a security agreement with the hose base Information Protection Office (IPO). Provide the information requested by the Notification of Government Security Activity Clause, AFFARS 5352.204.9000, and Visitor Group Security Agreements Clause. SEE CONTINUATION PAGE (Attachment #1) Attachment #2 CUI Addendum. |
| Enter GCA name.: Holloman AFB, NM Contracting |
| Enter AAC of the contracting office.: FA4801 |
| Enter address (include zip code).: |
49 CON/PKA
490 First Street Holloman AFB, NM 88330 Enter address (include zip code).: 490 First St, Ste 2130 (Bldg 29) Holloman AFB, NM 88330
| Enter POC name.: Sally D. Roberts |
| Enter telephone number (include area code).: 5755725293 |
| Enter telephone number (include area code).: 5755725293 |
| Enter email address.: sally.roberts@us.af.mil |
| Enter title.: Contracting Officer |
| Enter the datesigned in format YYYYMMDD.: |
File details come from the government source that posted it. Updated .