Atch 7 DD Form 254.pdf
PDF 73 KB Posted
- Attached to
- Pioneering Aerospace Capabilities, Engineering and Research Federal contract opportunity
- Solicitation number
- FA2391-23-S-2403
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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PREVIOUS EDITION IS OBSOLETE.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:
June 30, 2025 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"
| CurrentPage: |
| PageCount: |
| Select classification from drop-down list.: CUI |
| Enter serial number.: |
| a. Facility clearance level. Select one.: 1 |
| 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.: FA2391-23-S-2403 |
| Enter due date in format YYYYMMDD.: |
| Enter date in format YYYYMMDD.: 20250311 |
| Enter revision number.: |
| Enter date in format YYYYMMDD.: |
| Enter final specification.: |
| Enter date in format YYYYMMDD.: |
| Select for "no.": 1 |
| Select for "no.": 1 |
| Select for "no.": 0 |
| Select for "no.": 0 |
| Select for "yes.": 0 |
| Select for "yes.": 0 |
| Select for "yes.": 1 |
| Select for "yes.": 1 |
| 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).: Doe, John |
| Enter CAGE code of the prime contractor.: TBD |
| Enter CAGE code of the prime contractor.: N/A |
| Enter CAGE code of the prime contractor.: TBD |
| 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).:
TBD
| Select to add row to locations.: |
| Select to remove last row from locations.: |
| Select to delete all signatures.: |
| Enter location(s).: |
TBD
| Enter general unclassified description of this procurement.: This hybrid BAA permits the study efforts on novel concepts as well as R&D contracts to mature specific technologies to appropriate TRLs depending on end use. R&D efforts under this program include but are not limited to: fundamental science, advanced technology demonstration, critical experiments, and ground and flight tests. Research sites will be limited to each task order and located at various research centers. The BAA will allow for the submittal of white papers. |
| Select for "a. CONTRACTOR.": 0 |
| Select for "a. CONTRACTOR.": 0 |
| 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.": 1 |
| Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 1 |
| 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.": 1 |
| 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).": 1 |
| 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.": 1 |
| 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.": JWICS access authorized |
| Enter infomration for "other.": AFFARS 5352.204-9000 applies. See Block 13. |
| Enter infomration for "other.": AFRL/TBD, ADDRESS Wright-Patterson AFB OH 45433-7542, Wright-PattersonAFRL/namejohndoe@us.af.mil |
Blk 18f: AFRL/TBD, ADDRESS, WPAFB OH 45433, namejohndoe@us.af.mil; namejohndoe@us.af.mil
| Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0 |
| Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0 |
| Select for "l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI). .": 1 |
| Select for "m.OTHER.": 1 |
| Select for "direct.": 0 |
| Select for ": 1 |
| Enter specification for "through".: AFRL/RQ for non-SAR material. Transmission of public release request via e-mail is not authorized. Allow 15 days for processing. |
| Enter public release authority.: AFRL/TBD |
ADDRESS Street, WPAFB OH 45433
| Select to add signature.: |
| Select to remove last signature.: |
| text: 32 Code of Federal Regulations, Part 117, National Industrial Security Program Operating Manual (NISPOM), 24 February 2021, applies. |
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.
SECURITY GUIDANCE:
Access to classified information may be required during pre-contract phases, and will be dependent upon each individual task order.
Ref Item 10e (1): Public release of Sensitive Compartmented Information (SCI) is not authorized.
Ref Item 10e(1): Contractor requires access to SCI materials; SCI security requirements apply, see 21 IS/INS, SSO WPAFB, SCI addendum, for details. Access to Joint Worldwide Intelligence Communications System (JWICS) is authorized. Users shall be briefed to NATO Secret IAW the NISPOM, Para 10-706, prior to access.
Ref Blks 10j/11l: The contractor shall comply with DoDI 5200.48, Controlled Unclassified Information; AFMAN 16-1404, volume 1, Operations Support, Information Security Program: Overview, Classification, and Declassification; Air Force Guidance Memorandum 2020-16-01, Air Force Guidance Memorandum for CUI, 23 July 2020; and DoDM 5400.7-Air Force Manual 33 302, 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 Item 11c: Any classified information generated in the performance of this contract shall require the contractor to apply derivative classification and markings consistent with the source material.
Ref Item 11d: The contractor is required to provide adequate and approved storage for classified hardware or material to the level of SECRET which because of size or quantity cannot be safeguarded in an approved storage container.
Ref Item 11m: Provide the information requested by the Notification of Government Security Activity and Visitor Group Agreements clause, Air Force Federal Acquisition Regulation Supplement (AFFARS) 5352.204-9000, to: AFRL/RQOS, Information Protection Office, 2130 8th St, WPAFB, OH 45433, AFRL.RQEastDL-Security@us.af.mil. The contractor shall comply with DoDM 5220.22 Vol 2_AFMAN 16-1406 Vol 2, National Industrial Security Program: Industrial Security Procedures for Government Activities, 8 May 20, by following security procedures of the installation IAW para 3.8.a.; report adverse information IAW para 4.14 (Added)(AF); and support commander self-inspections and self-assessments IAW para 14.1.f (Added)(AF).
* AFRL/RQ Security (RQOS) office must approve further disclosure of information covered under this effort, to include subcontracting.
* Upon the end of this effort, the contractor shall contact the AFRL/RQOS for disposition instructions of classified access or material generated or received during this effort.
* Any classified or covered defense information under this effort cannot be transferred or used for another effort to include IRAD, unless express written approval is received from AFRL/RQ PM or AFRL/RQOS.
* Contractor personnel shall utilize US Government or official company email for transmitting official US Government business/information. US Government information shall NOT be transmitted via personal, private or commercial email or social media accounts (e.g. Hotmail, Gmail, Yahoo, Tik Tok, Facebook etc.). The use of DOD Safe is authorized for unclassified and Controlled Unclassified Information only.
* Contractor personnel are strictly prohibited from referencing this contract, classification, clearances, accesses (SAP/SAR, SCI), in advertisements, websites, capability fliers, promotional efforts or even in retirement notifications of employees.
* Contractors will complete the customer-provided Intelligence Oversight training as required by customer requirements and will report any Questionable Intelligence Activity (QIA), Significant/Highly Sensitive Matter (S/HSM), and/or Federal Crimes IAW procedures established in DoD Directive 5148.13, Intelligence Oversight, and AFI 14-104, Intelligence Oversight. For contracts involving cryptographic matters in addition to DoDD and AFI reference, USSID 18, Legal Compliance and US. Persons Minimization Procedures.
Program Manager: NAME JOHN DOE, AFRL/TBD, (937) XXX-XXXX, namejohndoe@us.af.mil
Administrative Contracting Officer: NAME JOHN DOE, AFRL/TBD, (937) XXX-XXXX, namejohndoe@us.af.mil
Security Manager: TBD, AFRL/TBD, (937) XXX-XXXX , namejohndoe@us.af.mil; TBD, AFRL/TBD, (937) XXX-XXXX, namejohndoe.31@us.af.mil text:
RQOS- Security Coordination
| Click on this button to attach a file(s).: |
| rep: TBD |
Chief of Security, AFRL/TBD
| Enter signature.: |
| Explain and identify specific areas and government activity responsible for inspections.: Ref Blk 11j: OPSEC requirements apply. See Statement of Work (SOW) for requirements. |
| Explain and identify specific areas and government activity responsible for inspections.: Ref Item 11m: Contractor performance will occur at TBD. DCSA is relieved of all inspection responsibilities for contractor performance on the installation. AFRL/TBD will maintain security and inspection oversight for collaterally classified information on the installation. |
Ref Item 10e (1): TBD, SSO WPAFB (937-XXX-XXXX) has exclusive security responsibility for SCI classified material released or developed under this contract. SCI security requirements apply, see SCI addendum (para 16) for details.
| Enter GCA name.: TBD |
| Enter AAC of the contracting office.: FA2391 |
| Enter AAC of the contracting office.: FA2391 |
| Enter address (include zip code).: |
TBD
Enter address (include zip code).:
TBD
| Enter POC name.: John Doe |
| Enter telephone number (include area code).: |
| Enter email address.: namejohndoe@us.af.mil |
| Enter email address.: namejohndoe@us.af.mil |
| Enter title.: TBD |
| Enter the datesigned in format YYYYMMDD.: |
File details come from the government source that posted it. Updated .