D1Atch04AppDDDFM254.doc
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- Attached to
- Systems Engineering and Technical Assistance (SETA) IV Federal contract opportunity
- Solicitation number
- FA0021-09-R-0004
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Attachment 4 Appendix D - DD Form 254
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DRAFT Solicitation FA0021-09-R-0004 ## June 2009
| DEPARTMENT OF DEFENSE |
| 1. CLEARANCE AND SAFEGUARDING |
| CONTRACT SECURITY CLASSIFICATION SPECIFICATION |
| a. FACILITY CLEARANCE REQUIRED |
TOP SECRET
(The requirements of the DoD Industrial Security Manual apply to all aspects of this effort)
b. LEVEL OF SAFEGUARDING REQUIRED
NONE
| 2. THIS SPECIFICATION IS FOR: (X and complete as applicable) |
| 3. THIS SPECIFICATION IS: (X and complete as applicable) |
a. PRIME CONTRACT NUMBER
| a. ORIGINAL (Complete date in all cases) |
| Date (YYMMDD) |
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| TBD |
| FORMCHECKBOX |
20090604
b. SUBCONTRACT NUMBER
b. REVISED (Supersedes all previous specs) Revision No.
Date (YYMMDD)
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| c. SOLICITATION OR OTHER NUMBER |
| Due Date (YYMMDD) |
| c. FINAL (Complete Item 5 in all cases) |
| Date (YYMMDD) |
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| FA0021-09-R-0004 |
| 20090709 |
| FORMCHECKBOX |
| 4. IS THIS A FOLLOW-ON CONTRACT? |
| FORMCHECKBOX |
| YES |
| FORMCHECKBOX |
NO. If Yes complete the following
Classified material received or generated under FA0021-05-D-0001/0002/0003 (Preceding Contract Number) is transferred to this follow-on contract
| 5. IS THIS A FINAL DD FORM 254? |
| FORMCHECKBOX |
| YES |
| FORMCHECKBOX |
NO. If Yes complete the following
In response to the contractor's request dated , retention of the identified classified material is authorized for the period of .
6. CONTRACTOR (Include Commercial and Government Entity ( CAGE) Code)
| a. NAME, ADDRESS, AND ZIP CODE |
| b. CAGE CODE |
| c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code) |
To be completed by Contractor
To be completed by Contractor – Full Defense Security Services (DSS) Address
7. SUBCONTRACTOR
| a. NAME, ADDRESS, AND ZIP CODE |
| b. CAGE CODE |
| c. COGNIZANT SECURITY OFFICES ( Name, Address, and Zip Code) |
8. ACTUAL PERFORMANCE
| a. LOCATION |
| b. CAGE CODE |
| c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code) |
Hurlburt Field, FL, and/or other locations as required by specific task orders under this contract.
| N/A |
| See Block/Item 15 of this form |
9. GENERAL IDENTIFICATION OF THIS PROCUREMENT
SETA IV Contract Support at Hurlburt Field, Florida. Specific security requirements will be made known at the task order level. The basic contract-level DD254 is provided for information only for the purpose of offerors under referenced solicitation.
| 10. THIS CONTRACT WILL REQUIRE ACCESS TO: |
| YES |
| NO |
| 11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL: |
| YES |
| NO |
a. COMMUNICATIONS SECURITY (COMSEC)
INFORMATION
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| a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT ANOTHER CONTRACTOR’S FACILITY OR A GOVERNMENT ACTIVITY |
| FORMCHECKBOX |
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| b. RESTRICTED DATA |
| FORMCHECKBOX |
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| b. RECEIVE CLASSIFIED DOCUMENTS ONLY |
| FORMCHECKBOX |
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| c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION |
| FORMCHECKBOX |
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| c. RECEIVE AND GENERATE CLASSIFIED MATERIAL |
| FORMCHECKBOX |
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| d. FORMERLY RESTRICTED DATA: |
| FORMCHECKBOX |
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| d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE |
| FORMCHECKBOX |
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e. INTELLIGENCE INFORMATION:
| e. PERFORM SERVICES ONLY |
| FORMCHECKBOX |
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| (1) Sensitive Compartmented Information (SCI) |
| FORMCHECKBOX |
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| f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE THE U.S., PUERTO RICO, U.S. POSSESSIONS AND TRUST TERRITORIES |
| FORMCHECKBOX |
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| (2) Non-SCI |
| FORMCHECKBOX |
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| g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER |
| FORMCHECKBOX |
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| f. SPECIAL ACCESS INFORMATION |
| FORMCHECKBOX |
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| h. REQUIRE A COMSEC ACCOUNT |
| FORMCHECKBOX |
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| g. NATO INFORMATION |
| FORMCHECKBOX |
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| i. HAVE A TEMPEST REQUIREMENT |
| FORMCHECKBOX |
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| h. FOREIGN GOVERNMENT INFORMATION |
| FORMCHECKBOX |
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| j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS |
| FORMCHECKBOX |
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| i. LIMITED DISSEMINATION INFORMATION |
| FORMCHECKBOX |
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| k. BE AUTHORIZED TO USE THE DEFENSE COURIER SERVICE |
| FORMCHECKBOX |
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| j. FOR OFFICIAL USE ONLY INFORMATION |
| FORMCHECKBOX |
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| l. OTHER (Specify). |
| FORMCHECKBOX |
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k. OTHER Specify) Automated Information Systems NIPRNET and SIPRNET
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Automated DD 254 (Dec 99)
12. PUBLIC RELEASE. Any information (classified or unclassified) pertaining to this contract shall not be released for public dissemination except as provided by the industrial
Security Manual or unless it has been approved for public release by appropriate U.S. Government authority. Proposed public release shall be submitted for approval prior to release to the Directorate for Freedom of Information and Security Review, Office of the Assistant Secretary of Defense (Public Affairs)* for review.
*In the case of non-DoD User Agencies, requests for disclosure shall be submitted to that agency.
FORMCHECKBOX
| Direct |
| FORMCHECKBOX |
Through (Specify):
None authorized. No release is authorized for SCO.
Contractor shall obtain Contracting Officer approval IAW DFARS 252.204-7000 for unclassified information release. All released shall be coordinated with the HQ AFSOC Public Affairs Office at Hurlburt Field, FL.
13. SECURITY GUIDANCE. The security classification guidance 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 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 document/guides/extracts referenced herein. Add additional pages as needed to provide complete guidance.
1. Supported USAF organizations will provide security classification guides and other classification guidance to the contractor as required for contract performance. Contractors will comply with all Hurlburt Field, supported unit and special program requirements. Supported units will provide security requirements and instructions, and will include contractors in the unit Information Security program.
2. Classified markings on all working, draft, and final copies of deliverable material shall be in accordance with Executive Order 12958, The Controlled Access Program Coordination Office (CAPCO) guidelines, DOD 5220.22-M, DoD 5200.1R and applicable instructions contained in the respective security classification guides.
3. For on-base contractors, the NISPOM security standards can be satisfied by incorporating AFI 31-401, Information Security Program Management requirements into the Visitor Group Security Agreement.
4. All classified material provided shall be returned by the contractor at contract completion. Individuals are responsible for safeguarding classified information entrusted to them.
5. Use only AF-certified AIS for performance on base and comply with all AF AIS procedures.
BLOCKS 10, 11, AND 13: SEE ATTACHED DD FORM 254 ADDENDA FOR SECURITY REQUIREMENTS. THE SECURITY LEVEL DETERMINES THE SECURITY REQUIREMENTS. APPROPRIATE GUIDANCE WILL BE GIVEN AT THE TASK ORDER LEVEL.
Hurlburt Field Servicing Security Agency:
1 SOW/IPC, 521 Cody Avenue (Bldg 90210), Hurlburt Field, FL 32544-5400
Telephone: 850-884-5143
| 14. ADDITIONAL SECURITY REQUIREMENTS. Requirements, in addition to ISM requirements, 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 cognizant security office. Use Item 13 if additional space is needed.) |
| FORMCHECKBOX |
| Yes |
| FORMCHECKBOX |
No
Provide the information requested by the Notification of Government Security Activity clause and Visitor Group Security Agreements Clause, AFFARS 5352.204-9000, to the Servicing Security Activity indicated in Item 13 above. Refer to the contract document for these clauses. The visitor group will operate per DoD 5200.1-R, AFI 31-401, AFI 31-601, Hurlburt Field supplements and unit security program operating instructions, plans and procedures.
APPROPRIATE GUIDANCE WITH BE IDENTIFIED AT THE TASK ORDER LEVEL.
15. INSPECTIONS. Elements of this contract are outside the inspection responsibility of the cognizant security office. (If Yes, explain and identify specific areas or elements carved out and the activity responsible for inspections. Use Item 13 if additional space is needed.
FORMCHECKBOX
| Yes |
| FORMCHECKBOX |
No
Long term visitor groups will be inspected as part of the supported organizations annual Information Security Program Review, conducted by the SSA, while operating on an Air Force Installation. The contractor will comply with the visitor group security agreement provided by the USAF Program/Project Manager at the performance location. The above does not apply to intelligence, SCI and SAP. APPROPRIATE GUIDANCE WITH BE IDENTIFIED AT THE TASK ORDER LEVEL.
16. CERTIFICATION AND SIGNATURE. 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.
a. TYPED NAME OF CERTIFYING OFFICIAL
JEFFREY L. LOWMAN
b. TITLE Contracting Officer
c. TELEPHONE (Include Area Code)
850-884-2022
| d. ADDRESS (Include ZIP Code) |
| 17. REQUIRED DISTRIBUTION |
427 Cody Avenue, Bldg 90333
Hurlburt Field, FL 32544-5407
| X |
| a. CONTRACTOR |
b. SUBCONTRACTOR
| X |
| c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR |
e. SIGNATURE
d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION
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e. ADMINISTRATIVE CONTRACTING OFFICER
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f. OTHERS AS NECESSARY 1 SOW/IPC
Automated DD 254 (Dec 99)
Attachment 4, Appendix D (Page 1 of 2)
File details come from the government source that posted it. Updated .