dd0254 Draft.pdf

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Attached to: 30 RS Mission Planning Software Tool (MPST)
Solicitation number: F3G1EB6257AG01
Issued by: Department of the Air Force Air Combat Command

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PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, APR 2018

NEEDS DD67

(Updated 20250815)

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:

August 31, 2028 The public reporting burden for this collection of information, 0704-0567, is estimated to average 36 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 Form 254, "DoD Contract Security Classification Specification" Show Attachment Bar

CurrentPage:

PageCount:

Classification (when form is filled in) (automatically filled from previous drop-down list): CUI

Serial Number:

1. CLEARANCE AND SAFEGUARDING - a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED

(See Instructions) - Select from drop-down list: 1

1. CLEARANCE AND SAFEGUARDING - b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/MATERIAL REQUIRED AT CONTRACTOR FACILITY - select from drop-down list: 1

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - Select for "a. PRIME CONTRACT NUMBER": 1

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - a. PRIME CONTRACT NUMBER (See instructions.): FA486126FZ027

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - Select for "b. SUBCONTRACT NUMBER": 0

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - b. SUBCONTRACT NUMBER:

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - Select for "c. SOLICITATION OR OTHER NUMBER": 0

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER:

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.) - c. SOLICITATION OR OTHER NUMBER - DUE DATE (YYYYMMDD):

3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "a. ORIGINAL (Complete date in all cases.) ": 1

3. THIS SPECIFICATION IS: (X and complete as applicable.) - a. ORIGINAL (Complete date in all cases.) : 20260601

3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "b. REVISED (Supersedes all previous specifications.)": 0

3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - REVISION NUMBER:

3. THIS SPECIFICATION IS: (X and complete as applicable.) - b. REVISED (Supersedes all previous specifications.) - DATE (YYYYMMDD):

3. THIS SPECIFICATION IS: (X and complete as applicable.) - Select for "c. FINAL (Complete Item 5 in all cases.)": 0

3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.):

3. THIS SPECIFICATION IS: (X and complete as applicable.) - c. FINAL (Complete Item 5 in all cases.) - DATE (YYYYMMDD):

4. IS THIS A FOLLOW-ON CONTRACT? - Select for "no.": 1

4. IS THIS A FOLLOW-ON CONTRACT? - Select for "yes.": 0

4. IS THIS A FOLLOW-ON CONTRACT? - If yes - Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract. - Enter preceding contract number.:

5. IS THIS A FINAL DD FORM 254? - Select for "no.": 1

5. IS THIS A FINAL DD FORM 254? - Select for "yes.": 0

5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of (period) - Enter contractor's request date in format YYYYMMDD.:

E5. IS THIS A FINAL DD FORM 254? - In response to the contractor's request dated (date), retention of the classified material is authorized for the period of - Enter period.:

6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code) - a. NAME, ADDRESS, AND ZIP CODE:

6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code) - b. CAGE CODE: 80SA5

6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code) - c. COGNIZANT SECURITY OFFICE(S) (CSO)

(Name, Address, ZIP Code, Telephone required; Email Address optional):

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) - Select to add row:

7. SUBCONTRACTOR(S) - Select to remove last row:

7. SUBCONTRACTOR(S) - Select to delete all rows:

7. SUBCONTRACTOR(S) - a. NAME, ADDRESS, AND ZIP CODE: N/A

7. SUBCONTRACTOR(S) - b. CAGE CODE: N/A

7. SUBCONTRACTOR(S) - c. COGNIZANT SECURITY OFFICE(S) (CSO)

(Name, Address, ZIP Code, Telephone required; Email Address optional): N/A

8. ACTUAL PERFORMANCE (Click button to add more locations.) - Select to add row :

8. ACTUAL PERFORMANCE - Select to remove last row:

8. ACTUAL PERFORMANCE - Select to delete all rows :

8. ACTUAL PERFORMANCE - a. LOCATION(S) (For actual performance, see instructions.): 30 RS

Creech AFB, NV 89018

8. ACTUAL PERFORMANCE - b. CAGE CODE (If applicable, see Instructions.): N/A

8. ACTUAL PERFORMANCE - c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional): 432 WG/AP

1065 Perimeter Road Creech AFB, NV 89018 United States

Enter general unclassified description of this procurement.: The contractor shall provide timely remote and periodic on-site support to the 30RS for MPST. The contractor will maintain compatibility with upgrades to the RQ-170 mission planning system software, hardware, operating systems and databases. The contractor will utilize current intelligence products to inform updates with the software. The contractor will accurately represent new and/or improved aircraft capabilities, correct errors and address limitations encountered during operational use of the MPST software. This includes providing personnel, services, and management support to accomplish these objectives.

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION.": 1

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "b. RESTRICTED DATA.": 0

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.).": 0

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "d. FORMERLY RESTRICTED DATA.": 0

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: Select for "(1) Sensitive Compartmented Information (SCI).": 1

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: Select for "(2) Non-SCI.": 1

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION.": 1

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "g. NORTH ATLANTIC TREATY ORGANIZATION (NATO) INFORMATION.": 0

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "h. FOREIGN GOVERNMENT INFORMATION.": 1

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "i. ALTERNATIVE COMPENSATORY CONTROL MEASURES (ACCM) INFORMATION.": 1

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "j. CONTROLLED UNCLASSIFIED INFORMATION (CUI).": 1

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - Select for "k. OTHER .": 1

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.) - k. OTHER (Specify) (See instructions.): SIPRNET, JWICS and STE

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.) - Select for "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.): 1

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.) - Select for "b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY.": 0

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.) - Select for "c. RECEIVE, STORE, AND GENERATE CLASSIFIED INFORMATION OR MATERIAL.": 0

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.) - Select for "d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE.": 0

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.) - Select for "e. PERFORM SERVICES ONLY.": 0

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.) - Select for "f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE THE U.S.,PUERTO RICO, U.S. POSSESSIONS AND TRUST ERRITORIES.": 0

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.) - Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0

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.) - Select for "h. REQUIRE A COMSEC ACCOUNT.": 0

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.) - Select for "i. HAVE A TEMPEST REQUIREMENT.": 0

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.) - Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1

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.) - Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0

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.) - Select for "l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI)." (DoD Components: refer to DoDI 5200.48, only for specific CUI protection requirements. Non-DoD Components: see instructions.): 1

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.) - Select for "m. OTHER.": 0

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.) - 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) - Select for "DIRECT": 0

12. PUBLIC RELEASE - Select for "THROUGH": 1

12. PUBLIC RELEASE - Enter specification for "through".: (See continuation in block 13) HQ ACC/A8Z

204 Dodd Blvd, Ste 160 Langley AFB VA 23665

12. PUBLIC RELEASE - Public Release Authority:: NOTE: PUBLIC RELEASE OF CLASSIFIED INFORMATION, TO INCLUDE SAP IS NOT AUTHORIZED.

13. SECURITY GUIDANCE - Select to add signature row:

13. SECURITY GUIDANCE - Select to remove last signature row:

13. SECURITY GUIDANCE - Select to delete all signature rows:

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.

All contractor personnel shall comply with the provisions of DoD 5220.22-M, National Industrial Security Program Operating Manual (NISPOM) Incorporating Change 2, May 2016; DoDI 5220.22, National Industrial Security Program, Incorporating Change 1, Effective May 2018; DoDM 5220.22, Vol. 2_AFMAN 16-1406 Vol. 2, National Industrial Security Program: Industrial Security Procedures for Government Activities, May 2020.

Ref 8a. Performance Locations - 30 RS, Creech AFB, NV 89018

Ref 10a. COMSEC - Contractor will require access to COMSEC information at the on-base locations listed in item 8a. Contractor will not require their own COMSEC account. Access will be controlled by the sponsoring agency. Contractor will protect COMSEC material IAW directives deemed necessary by the installation COMSEC officer. Access to COMSEC material by personnel is restricted to U.S. citizens holding final U.S. Government clearances. Such information is not releasable to personnel holding only reciprocal clearances.

Ref 10e. Intelligence - Contractor will require access to security directives specified in Attachment 1. Regulatory compliance is mandatory unless otherwise specified in writing by SSO CREECH

Ref 10f. Special Access Programs - The contractor must adhere to the special access requirements/procedures developed by the OPR. SAP performance at the contractor cleared facility is not authorized. Performance will be limited to government approved facilities. See attached SAP Addendum for additional SAP security requirements.

Ref 10h. Foreign Government Information – Access requires a final U.S. Government clearance at the appropriate level.

Ref 10i. Alternative Compensatory Control Measures (ACCM) - Contractor will require access to ACCM information at the government site in execution of the statement of work. The ACCM COR may determine additional program(s) access that may be required in execution of this contract. Contractor agrees to follow guidance outlined in applicable security classification guides, program security plans and policy as outlined in CJCSM 3213.02D, Joint Staff ACCM Manual, and DoDM 5200.01, Volumes 1-4, DoD Information Security Program and supporting documentation for each ACCM, including security classification guides, program security plans, and governing directives. Contact the 30 RS ACCM COR; Lt Col Brandon Carter, 432 Wing Advance Programs at Commercial number: 702-404-0003 or NIPR email: brandon.carter@us.af.milf for ACCM information and access.

Ref 10j. Controlled Unclassified Information (CUI) - CUI information provided under this contract shall be managed and safeguarded IAW DoD 5400.7-R, Chapter 4, DoD Freedom of Information Act (FOIA) Program, DoDM 5200.01, Volume 4, DoDI 5200.48 Controlled Unclassified Information (CUI) and attached CUI Addendum.

Ref 10k. Other - SIRPNET, JWICS, STE - Accounts are authorized on a case-by-case basis to contractors. Task Order Manager/Task Order Leader must provide written approval to the site security manager and contractor must complete Classified Information Systems training IAQ AF 16-1404 Para 6.2.3, Air force Information Security Program and local requirements for account access. Local security manager will assist in obtaining access.

SIPRNET- 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, ACC, and local base instructions and policies. Sponsoring government agency will provide Information Assurance training prior to contractor access to network services.

JWICS - The government will only provide JWICS network access to include email and web access provided the contractor meets ‘all’ SCI eligibility and training requirements and maintains the appropriate SCI access level. Contractors will be held strictly accountable for all actions they initiate on the network and will conduct business IAW USAF, ACC, and local base instructions and policies. JWICS privileges will be terminated if contractor does not maintain a current TS investigation.

STE - STE/Secure VOIP access is required for contract performance. Access will be controlled by the sponsoring agency. Contractor will follow requirements IAW AFMAN 33-283, Communications Security (COMSEC) Operations.

11a. a. Have access to classified information only at another contractor’s facility or a government activity. - Contract performance is restricted to the locations identified in item 8a. The highest level of security clearance required for contract performance is Top 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.

Ref 11j. Have OPERATIONS security (OPSEC) requirements - Contractor will follow base and unit Operations Security guidance (SOPs, OIs, etc) for the locations identified in item 8a. A copy of the local guidance will be provided to the contractor.

Ref 12 Public Release Authority (continue) -

HQ ACC/A2S HQ ACC/PA HQ USAF/A2RS-CSA

209 Thornell Avenue 115 Thompson Street, Ste 211 1700 AF Pentagon Langley AFB VA 23665 Langley AFB VA 23665 Washington DC

Note: For Official Use Only (FOUO) Information Description: Is a Government protective marking/caveat designation applied to unclassified information that may be exempt from mandatory release to the public because of foreseeable harm to an interest protected by the Freedom of Information Act (FOIA), as implemented by DoD 5400.7-R and/or the Privacy Act of 1974, as amended.

Note: PUBLIC RELEASE OF CLASSIFIED INFORMATION, TO INCLUDE SCI AND SAP IS NOT AUTHORIZED

Note: PUBLIC RELEASE OF CLASSIFIED INFORMATION, TO INCLUDE SAP IS NOT AUTHORIZED

List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form) - Click on this button to attach a file(s).:

Reviewing Official’s Office Symbol, phone and email (1): Contracting Officer Representative (COR)

NAME & TITLE OF REVIEWING OFFICIAL (1):

17. CERTIFICATION AND SIGNATURES - h. SIGNATURE :

Reviewing Official’s Office Symbol, phone and email (2): Special Security Officer (SSO)

NAME & TITLE OF REVIEWING OFFICIAL (2):

SIGNATURE (2):

Reviewing Official’s Office Symbol, phone and email (3): 432 WG/AP Creech AFB, NV 89018

NAME & TITLE OF REVIEWING OFFICIAL (3):

SIGNATURE (3):

Reviewing Official’s Office Symbol, phone and email (4): AFOSI/PJ DET 1

SAP PJO

NAME & TITLE OF REVIEWING OFFICIAL (4):

SIGNATURE (4):

Reviewing Official’s Office Symbol, phone and email (5):

NAME & TITLE OF REVIEWING OFFICIAL (5):

SIGNATURE (5):

Reviewing Official’s Office Symbol, phone and email (6):

NAME & TITLE OF REVIEWING OFFICIAL (6):

SIGNATURE (6):

14. ADDITIONAL SECURITY REQUIREMENTS - Requirements, in addition to NISPOM requirements for classified information, are established for this contract. - Select for "no.": 0

14. ADDITIONAL SECURITY REQUIREMENTS - Requirements, in addition to NISPOM requirements for classified information, are established for this contract. - Select for "yes.": 1

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.): Upon notification of the presence of a visitor group, the Chief, Information Protection will provide the local security policies where classified performance will occur. These procedures must be in writing (e.g. email, electronic media, or paper). Prior approval of the contracting activity is required for subcontracting.

Visitor Groups will safeguard all collateral classified information IAW DoDM5220.22 V2_AFMAN16-1406 V2; National Industrial Security Program, DoDM5200.01 Volumes 1 thru 3_DAFMAN16-1404 Volumes 1 thru 3; Information Security Program, and other directives deemed necessary by the servicing IPO.

See attachment for additional SAP security requirements.

15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "no.": 0

15. INSPECTIONS - Elements of this contract are outside the inspection responsibility of the CSO. - Select for "yes.": 1

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.): When contractors are designated as Visitor Groups on Air Force installations, Industrial Security Reviews for collateral classified information will be conducted by the servicing IPO. Defense Counter-Intelligence Security Agency retains cognizance over the cleared contractor facility. Contractor will follow base and unit Operations Security guidance (SOPs, OIs, etc) for the locations identified in item 8a. A copy of the local guidance will be provided to the contractor.

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - a. GCA NAME: ACC/432 MSG/CONS

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions): FA4861

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - c. ADDRESS (Include ZIP Code): 99 CONS

5865 Swaap Blvd, Bldg 588 Nellis AFB, NV 89191-7063

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - d. POC NAME: Capt Taylor Peeples

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - e. POC TELEPHONE (Include Area Code): 7024041112

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC) - f. EMAIL ADDRESS (See Instructions): taylor.peeples.1@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): Peeples, Taylor M.

17. CERTIFICATION AND SIGNATURES - b. TITLE : CONTRACTING OFFICER

17. CERTIFICATION AND SIGNATURES - c. ADDRESS (Include ZIP Code): 99 CONS

5865 Swaab Blvd. Bldg. 588 Nellis AFB NV 89191-7063

17. CERTIFICATION AND SIGNATURES - d. AAC OF THE CONTRACTING OFFICE (See Instructions): FA4861

17. CERTIFICATION AND SIGNATURES - e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.): 80SA5

17. CERTIFICATION AND SIGNATURES - f. TELEPHONE (Include Area Code): 7024041112

17. CERTIFICATION AND SIGNATURES - g. EMAIL ADDRESS (See Instructions): taylor.peeples.1@us.af.mil

17. CERTIFICATION AND SIGNATURES - i. DATE SIGNED (See Instructions):

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "a. CONTRACTOR.": 1

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "b. SUBCONTRACTOR.": 0

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 1

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 1

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Select for "f. OTHER AS NECESSARY.": 1

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL - Enter specification for "other." (If more room is needed, continue in Item 13 or on additional page if necessary.):

File details come from the government source that posted it. Updated Nov 6, 2026.