Attachment_2_DD_254.pdf
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- Attached to
- Pad Safety Federal contract opportunity
- Solicitation number
- FA2521-15-R-0002
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Attachment 2 PSSC DD254
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DEPARTMENT OF DEFENSE
CONTRACT SECURITY CLASSIFICATION SPECIFICATION
(The requirements of the DoD Industrial Security Manual apply to all security aspects of this effort.)
1. CLEARANCE AND SAFEGUARDING
a. FACILITY CLEARANCE REQUIRED
b. LEVEL OF SAFEGUARDING REQUIRED
2. THIS SPECIFICATION IS FOR: (X and complete as applicable)
a. PRIME CONTRACT NUMBER
b. SUBCONTRACT NUMBER
c. SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMDD)
3. THIS SPECIFICATION IS: (X and complete as applicable)
a. ORIGINAL (Complete date in all cases)
REVISION NO.
c. FINAL (Complete Item 5 in all cases)
DATE (YYYYMMDD)
b. REVISED (Supersedes all previous specs)
DATE (YYYYMMDD)
DATE (YYYYMMDD)
4. IS THIS A FOLLOW-ON CONTRACT? YES NO. 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? YES NO. 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 b. CAGE CODE c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code)
7. SUBCONTRACTOR
a. NAME, ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code)
8. ACTUAL PERFORMANCE
a. LOCATION b. CAGE CODE c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code)
9. GENERAL IDENTIFICATION OF THIS PROCUREMENT
10. CONTRACTOR WILL REQUIRE ACCESS TO: 11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL:YES NO YES NO
a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION
b. RESTRICTED DATA
c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION
d. FORMERLY RESTRICTED DATA
e. INTELLIGENCE INFORMATION
(1) Sensitive Compartmented Information (SCI)
(2) Non-SCI
f. SPECIAL ACCESS INFORMATION
g. NATO INFORMATION
h. FOREIGN GOVERNMENT INFORMATION
i. LIMITED DISSEMINATION INFORMATION
j. FOR OFFICIAL USE ONLY INFORMATION
k. OTHER (Specify)
a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT ANOTHER
CONTRACTOR'S FACILITY OR A GOVERNMENT ACTIVITY
b. RECEIVE CLASSIFIED DOCUMENTS ONLY
c. RECEIVE AND GENERATE CLASSIFIED 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 TEMPEST REQUIREMENTS
j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS
k. BE AUTHORIZED TO USE THE DEFENSE COURIER SERVICE
l. OTHER (Specify)
DD FORM 254, DEC 1999 PREVIOUS EDITION IS OBSOLETE. Adobe Professional 7.0
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 releases shall be submitted for approval prior to release
a. TYPED NAME OF CERTIFYING OFFICIAL
Direct Through (Specify)
d. ADDRESS (Include Zip Code)
Yes No 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.
13. SECURITY GUIDANCE. The security classification guidance needed for this classified 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. Add additional pages as needed to provide complete guidance.)
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.)
Yes No15. 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.)
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.
b. TITLE c. TELEPHONE (Include Area Code)
e. SIGNATURE
17. REQUIRED DISTRIBUTION
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. OTHERS AS NECESSARY
DD FORM 254 (BACK), DEC 1999
| fac_clear: Secret |
| safe_level: Secret |
| prime_no: |
| xprime: Off |
| sub_no: |
| xsub: Off |
| xsolic: Yes |
| solic_no: FA2521-15-R-0002 |
| due_date: 20161001 |
| xspec3: Orig |
| orig_date: |
| rev_no: |
| rev_date: |
| final_date: |
| xfollowon: Yes |
| prec_no: FA2521-11-C-0026 |
| xfinal: No |
| req_dated: |
| period: |
| ctr_name: |
| ctr_cage: |
| ctr_ofc: Defense Security Service |
Melbourne Field Office (IOFSM) 6767 North Wickham Road, Suite 208 Melbourne, FL 32940
| sub_name: |
| sub_cage: |
| sub_ofc: |
| perf_loc: See Item #13 |
| perf_cage: |
| perf_ofc: 45 Space Wing |
Information Protection Office
45 SW/IP
1201 Edward H. White II Street Patrick AFB, FL 32925
| gen_id: Re-procurement for Pad Safety technical support |
| x10a: No |
| x10b: Yes |
| x10c: No |
| x10d: Yes |
| x10e1: No |
| x10e2: No |
| x10f: No |
| x10g: No |
| x10h: Yes |
| x10i: No |
| x10j: Yes |
| x10k: Yes |
| other10k: Personal Data |
| x11a: Yes |
| x11b: Yes |
| x11c: Yes |
| x11d: Yes |
| x11e: Yes |
| x11f: Yes |
| x11g: Yes |
| x11h: Yes |
| x11i: Yes |
| x11j: Yes |
| x11k: Yes |
| x11l: Yes |
| other11l: AFFAR SUP CLAUSE 5352.204-9000 NOTIFICATION OF GOVERNMENT SECURITY ACTIVITY. SEE ITEM 13 FOR AUTOMATED SYSTEMS SECURITY. |
| xrelease: No |
| release_thru: 45th Space Wing Public Affairs Office Bldg 423, Room 133 |
1201 Edward H. White II St. Tel. (321) 494-5933 Patrick AFB, FL 32925-3237 DSN: 854-7331 guidance: a. Item 8a Continued
45 SW/SE 45 SW/PSSC
Cape Canaveral AFS, FL Patrick AFB, FL 32925-2206 32925 Reference 10B & 10D: Access to restricted Data (RD) information which is classified and controlled under the Atomic Energy Act of 1954 or Formerly Restricted Data (FRD) is required. Both RD and FRD mandate a final U.S. Government security clearance at the appropriate level prior to access.
Reference 10H: NISPOM, Chapter 10, Section 3, Provides further guidance for FGI information.
Reference 10J: FOUO information will be safeguarded IAW AFI 37-132, AF Privacy Act Program, and AFI 37-131, AF Freedom of Information Program.
Reference 11C: General Security Classification Guidance & Appropriate Security Classification Guides will be provided by the Program Manager, as needed.
Item 10k. The contractor will establish and maintain Information Assurance (IA) security programs to protect government information processed. Contractor will comply with the major command and wing IA policy and instructions. Contractor will provide appointment letters of unit primary and alternate IA focal points to applicable government oversight office. The Wing Information Assurance Office (WIAO) will provide DoD, AF, AFSPC, 45 SWI and IA guidance and training for the following IA disciplines; Computer Security (COMPUSEC), IA Awareness Program, and Telecommunications Monitoring Assessment Program (TMAP).
45 SW/IP Coord ______________________________ 45 SCS Coord _________________________________________
| xaddlsec: Yes |
| addl_sec: The contractor/sub-contractors shall enter into a visitor group security agreement (VGSA) as required by AFI 31-601 for their activities while on 45 SW installations. Contact the 45 SW/IP for guidance. |
| xinsp: Yes |
| inspections: DSS is relieved of all industrial security inspections for contractor performance at Air Force installations. Inspections will be conducted according to the local visitor group security agreement established between the contractor and the local Information Protection Office. |
| cert_name: Bill Wilson |
| cert_title: Pad Safety Program Manager |
| cert_phone: 321-494-7222 |
| cert_addr: 45SW/SE |
1201 Edward H White II Street, Bldg 423, Room N316-29 Patrick AFB, FL 32925
| cert_sign: |
| x17a: Yes |
| x17b: Off |
| x17c: Yes |
| x17d: Off |
| x17e: Yes |
| x17f: Yes |
| other_dist: 45 SW/IP |
| Reset: |
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