Atch5_SectJ_dd254.pdf

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SATOC Federal contract opportunity
Solicitation number
FA3002-06-R-0001
Issued by
Department of the Air Force Materiel Command Installation and Mission Support Center Installation Contracting Agency

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DD Form 254 Section J Atch 5

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Text version

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.

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 classifiection 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

a_FACILITY_CLEARANCE_REQU: Determined at Task Order Level
b_LEVEL_OF_SAFEGUARDING_R: Determined at Task Order Level
FillText1: Off
a_PRIME_CONTRACT_NUMBER: Determined at Task Order Level
DATE_YYYYMMDD:
FillText3: Off
b_SUBCONTRACT_NUMBER:
REVISION_NO:
DATE_YYYYMMDD1:
FillText5: Off
c_SOLICITATION_OR_OTHER_N: Determined at Task Order Level
DUE_DATE_YYYYMMDD:
DATE_YYYYMMDD2:
YES1:
FillText12:
FillText11:
a_NAME_ADDRESS_AND_ZIP_CO: Determined at Task Order Level
b_CAGE_CODE:
c_COGNIZANT_SECURITY_OFFI:
a_NAME_ADDRESS_AND_ZIP_C1: Determined at Task Order Level
b_CAGE_CODE1:
c_COGNIZANT_SECURITY_OFF1:
a_LOCATION: Determined at Task Order Level
b_CAGE_CODE2:
c_COGNIZANT_SECURITY_OFF2:
9_GENERAL_IDENTIFICATION: Determine at Task Order Level
a_COMMUNICATIONS_SECURIT1: Off
a_COMMUNICATIONS_SECURIT2: Off
b_RESTRICTED_DATA1: Off
b_RESTRICTED_DATA2: Off
c_CRITICAL_NUCLEAR_WEAPO1: Off
c_CRITICAL_NUCLEAR_WEAPO2: Off
d_FORMERLY_RESTRICTED_DA1: Off
d_FORMERLY_RESTRICTED_DA2: Off
1_Sensitive_Compartmente1: Off
1_Sensitive_Compartmente2: Off
2_NonSCI1: Off
2_NonSCI2: Off
f_SPECIAL_ACCESS_INFORMA1: Off
f_SPECIAL_ACCESS_INFORMA2: Off
g_NATO_INFORMATION1: Off
g_NATO_INFORMATION2: Off
h_FOREIGN_GOVERNMENT_INF1: Off
h_FOREIGN_GOVERNMENT_INF2: Off
i_LIMITED_DISSEMINATION_1: Off
i_LIMITED_DISSEMINATION_2: Off
j_FOR_OFFICIAL_USE_ONLY_I: Off
j_FOR_OFFICIAL_USE_ONLY_1: Off
k_OTHER_Specify: Off
k_OTHER_Specify1: Off
a_COMMUNICATIONS_SECURIT3: Off
a_COMMUNICATIONS_SECURIT4: Off
b_RESTRICTED_DATA3: Off
b_RESTRICTED_DATA4: Off
c_CRITICAL_NUCLEAR_WEAPO3: Off
c_CRITICAL_NUCLEAR_WEAPO4: Off
d_FORMERLY_RESTRICTED_DA3: Off
d_FORMERLY_RESTRICTED_DA4: Off
e_INTELLIGENCE_INFORMATI3: Off
e_INTELLIGENCE_INFORMATI4: Off
1_Sensitive_Compartmente3: Off
1_Sensitive_Compartmente4: Off
2_NonSCI3: Off
2_NonSCI4: Off
f_SPECIAL_ACCESS_INFORMA3: Off
f_SPECIAL_ACCESS_INFORMA4: Off
g_NATO_INFORMATION3: Off
g_NATO_INFORMATION4: Off
h_FOREIGN_GOVERNMENT_INF3: Off
h_FOREIGN_GOVERNMENT_INF4: Off
i_LIMITED_DISSEMINATION_3: Off
i_LIMITED_DISSEMINATION_4: Off
1_OTHER_Specify:
FillText13: Off
FillText14: Off
a_TYPED_NAME_OF_CERTIFYIN:
b_TITLE:
c_TELEPHONE_Include_Area:
d_ADDRESS_Include_Zip_Cod:
e_SIGNATURE:
FillText21: Off
FillText22: Off
FillText23: Off
FillText24: Off
FillText25: Off
FillText26: Off
f_OTHERS_AS_NECESSARY:
FillText15:
FillText16:
other1:
release:
security:

Determined at Task Order Level

addit_sec:
Inspections:
Reset:
4_Yes: Off
4_No: Off
5_Yes: Off
5_No: Off
12_Public_Release_Direct: Off
12_Public_Release_Through: Off
13_Rules:
13_2:
14_Yes: Off
14_No: Off
15_Yes: Off
15_No: Off
3_A: Off
3_B: Off
3_C: Off

File details come from the government source that posted it. Updated .