Atch_7_DD_254.pdf

CLASSIFICATION (When filled in): Unclassified

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AEM LiveCycle Designer

DD FORM 254, APR 2018

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:

October 31, 2020

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

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED (See Instructions)

Top Secret

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

Top Secret

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.)

a. PRIME CONTRACT NUMBER (See instructions.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

FA4690-19-Q-A035

DUE DATE (YYYYMMDD)

3. THIS SPECIFICATION IS: (X and complete as applicable.)

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20190620

b. REVISED (Supersedes all previous specifications.)

REVISION NO. DATE (YYYYMMDD)

c. FINAL (Complete Item 5 in all cases.) DATE (YYYYMMDD)

4. IS THIS A FOLLOW-ON CONTRACT? No Yes If yes, complete the following:

Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract.FA4690-15-D-0005

5. IS THIS A FINAL DD FORM 254? No Yes 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(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

Defense Security Service Phoenix Field Office (IOFWX) 10851 Black Canyon Hwy, Ste. 860 Phoenix, AZ 85029-4755

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)

a. NAME, ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

8. ACTUAL PERFORMANCE (Click button to add more locations.)

a. LOCATION(S) (For actual performance, see instructions.)

89th Attack Squadron, Bldg. 1008 1432 Spaatz Dr.

Ellsworth AFB, SD 57706

b. CAGE CODE (If applicable, see Instructions.)

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Contract will provide administrative support for the flying operations of the 89th Attack Squadron. Support includes Security Administration Manager, Stan/Eval Technician, Personnel Security Support, and Physical Security Support.

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10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

b. RESTRICTED DATA

g. NORTH ATLANTIC TREATY ORGANIZATION

(NATO) INFORMATION

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.)

h. FOREIGN GOVERMENT INFORMATION

d. FORMERLY RESTRICTED DATA

i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

e. NATIONAL INTELLIGENCE INFORMATION:

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI) (See instructions.)

k. OTHER (Specify) (See instructions.)

Access to SIPRNET (Requires NATO Brief)

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.)

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.)

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE, STORE, AND GENERATE CLASSIFIED

INFORMATION OR 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 A TEMPEST REQUIREMENT

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE

l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED

INFORMATION (CUI).

(DoD Components: refer to DoDM 5200.01, Volume 4 only for specific CUI protection requirements. Non-DoD Components: see 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)

DIRECT THROUGH (Specify below)

28 BW/PA and SSO, 1958 Scott Dr., Ellsworth AFB, SD 57706 HQ USAF/A2RS-CSA, 1700 AF Pentagon, Washington DC 20330

Public Release Authority:

PUBLIC RELEASE AS CLASSIFIED INFORMATION TO

INCLUDE SCI IS NOT AUTHORIZED

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.)

Ref 10a. 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(1)(2). Contractor will require access to security directives specified in Attachment 1. Regulatory compliance is mandatory unless otherwise specified in writing by SSO ACC.

Ref 10g. Special briefings are required for access to NATO IAW AFI16-1404, Air Force Information Security Program. Prior approval of the contracting activity is required for subcontracting. Access to classified NATO information requires a final U.S. Government clearance at the appropriate level.

Ref 10j & 11l. For Official Use Only (FOUO) and other Controlled Unclassified Information (CUI) information provided under this

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contract shall be managed and safeguarded IAW DoD 5400.7-R, Chapter 4, DoD Freedom of Information Act (FOIA) Program as specified in Attachment 2 and DoDM 5200.01, Volume 4.

Ref 10k. 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.

Ref 11a. 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. 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.

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 20330

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

List of Attachments [2] (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form)

2019 SSO Addendum DDFM254.pdf FOUO STATEMENT.pdf

HQ ACC/IP

757-764-2970

NAME & TITLE OF REVIEWING OFFICIAL

G. TIMOTHY PATTERSON, GS-15, DAF

Director, Information Protection

SIGNATURE

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, are established for this contract.

No Yes 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.)

Visitor Group contractors are required to enter into a security agreement with the host base Information Protection Office (IPO). Provide the information requested by the Notification of Government Security Activity Clause, AFFARS 5352.204.9000, and Visitor Group Security Agreements Clause. Visitor Groups will safeguard all collateral classified information IAW DoD 5200.01 Vol 3, Protection of Classified Information, AFI 16-1404, Information Security Program Management; AFI 16-1406, Industrial Security Program Management, and other directives deemed necessary by the servicing IPO. Prior approval of the contracting activity is required for subcontracting. See attachment 2 for Release of SCI Intelligence/Non-Intelligence Information.

15. INSPECTIONS

Elements of this contract are outside the inspection responsibility of the CSO.

No Yes 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 Security Activity. SSO ACC (HQ ACC/A2S) has exclusive security responsibility for all SCI classified material released to or developed under this contract and held at the government SCI facility and/or the contractor’s SCI facility.

Defense Security Service retains cognizance only over non-SCI material released to or developed under the contract and held within the contractor’s SCI facility or cleared facility.

PATTERSON.GEO

RGE.T.1053823765

Digitally signed by

PATTERSON.GEORGE.T.10538

23765 Date: 2019.06.20 14:49:50 -04'00'

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16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)

a. GCA NAME

Mark Salyer, GS-13, DAF

b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)

FA4690

c. ADDRESS (Include ZIP Code)

28 CONS/PKA

1000 Ellsworth St., Ste. 1200 Ellsworth AFB, SD 57706

d. POC NAME

Kathleen G. Green

e. POC TELEPHONE (Include Area Code)

+1 (605) 385-1743

f. EMAIL ADDRESS (See Instructions) kathleen.green@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)

Mark Salyer, GS-13, DAF

b. TITLE

Section Supervisor/PKA Contracting Officer

c. ADDRESS (Include ZIP Code)

28 CONS/PKA

1000 Ellsworth St., Ste. 1200 Ellsworth AFB, SD 57706

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

FA4690

e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.)

f. TELEPHONE (Include Area Code)

+1 (605) 385-1742

g. EMAIL ADDRESS (See Instructions) mark.salyer@us.af.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

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. OTHER AS NECESSARY (If more room is needed, continue in Item 13 or on additional page if necessary.)

ACC/SSO Langley AFB VA