Appendix_O_-_Security_Information.pdf

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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)

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 X

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: N/A prime_no:

xprime: Off sub_no:

xsub: Off xsolic: Off solic_no: FA4890-15-R-0007 due_date:

xspec3: Orig orig_date:

rev_no:

rev_date:

final_date:

xfollowon: Yes prec_no: FA4890-11-C-0005 xfinal: No req_dated:

period:

ctr_name: TBD ctr_cage:

ctr_ofc: Defense Security Service 5800 E. Campus Circle Drive, #110 A Irving, TX 75063 sub_name:

sub_cage:

sub_ofc:

perf_loc: See Item 13...Specific locations listed on attached document perf_cage:

perf_ofc:

gen_id: T-38 Aircraft Maintenance in support of the Air Combat Command Aircraft Maintenance Program contract.

x10a: No x10b: Yes x10c: No x10d: Yes x10e1: No x10e2: No x10f: No x10g: No x10h: No x10i: No x10j: Yes x10k: No other10k:

x11a: Yes x11b: No x11c: No x11d: No x11e: Yes x11f: No x11g: No x11h: No x11i: No x11j: No x11k: No x11l: Off other11l:

xrelease: No release_thru: HQ ACC/PA

115 THOMPSON ST, STE 211

LANGLEY AFB, VA 23665 NOTE: PUBLIC RELEASE OF CLASSIFIED INFORMATION IS NOT AUTHORIZED.

guidance: Contract dates: Contract Program Manager: Stephen Brannen: 757-764-9128 (DSN: 574)

Item 8a: Bldgs 1226, 1243, 1244, (9 MXG/MOS) Beale AFB, CA, 95903; Bldgs 279, 280, 281, 282, 284, 300, 308, 309, 315, 577, 578, 580, 638, 639 (49 MXG/MOS) Holloman AFB, NM, 88330; Bldg 753 (1 MXG) Langley AFB, VA, 23665; Bldgs 156, 205, (53 WEG), Tydall AFB, FL, 32403; Bldg 52 (509 BW) Whiteman AFB, MO, 65305 Item 10 b+d: Access to RESTRICTED/FORMERLY RESTRICTED DATA requires a final U.S. Government Clearance at the appropriate level. Access to this information for this contract will only be required at Whiteman AFB, MO Item 10j: For Official Use Only (FOUO) information provided under this contract shall be managed and safeguarded IAW DoD 5400.7-R, Chapter 4, DoD Freedom of Information Act (FOIA) Item 11a: Contract performance is restricted to the locations identified in item 8a. The highest level of security clearance required for contract performance is 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 this contract.

FIRST LAST, Civ, DAF

HQ ACC/IP DSN 574-XXXX

Information Protection Office xaddlsec: Yes addl_sec: 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 and Visitor Group Security Agreements Clause, AFFARS 5352.204.9000, to the servicing Information Protection Office. (See continuation sheet) xinsp: Off inspections: When contractors are designated as Visitor Groups on the Air Force instillations, Industrial Security Reviews for collateral classified information will be conducted by the servicing Information Protection Office. Defense Security Service retains cognizance over the cleared contractor facility.

cert_name: Capt. Crystal L. Champion cert_title: Contracting Officer cert_phone: (757)-225-6321 cert_addr: ACC AMIC/PKC

11817 CANON BLVD, SUITE 306

NEWPORT NEWS, VA 23606-4516

x17a: Yes x17b: Off x17c: Yes x17d: Off x17e: Yes x17f: Yes other_dist:

Position Location Required Clearance

Director of Maintenance Holloman Secret

Deputy Director of Maintenance Holloman Secret

Site Leads/ Assistant Beale, Langley, Tyndall and

Whiteman Secret

Business Manager Holloman Secret

Quality Manager Holloman Secret

Technical Order Distribution Office Holloman Secret

(TODO)

OL Flightline Workers Beale OL None

OL Flightline Workers Langley OL Secret

OL Flightline Workers Tyndall OL Secret

OL Flightline Workers Whiteman OL Secret

Functional Check Pilot Holloman CRF Secret

T-38 AMP Contract Security Offices

9 RW/IP

5950 C. Street Beale AFB, CA 95903

DSN 368-2388

COM (530) 634-2388

9RW.Information.Protection@us.af.mil

49 WG/IP

490 First Street Holloman AFB, NM 88330

DSN 572-0890

COM (575) 572-0890

49.FW.InformationProtection@holloman.af.mil

509 BW/IP 1031

509 Spirit Blvd Ste 104C Whiteman AFB, MO 653305

DSN 975-5892

COM (660) 687-5892

509.BW.IP.Information.Protection@us.af.mil

325 FW/IP

Bldg. 530, 117 Texas Avenue Tyndall AFB, FL 32403

DSN 523-9093

COM (850) 283-9093

325fw.ip@us.af.mil

633 ABW/IP

120 Burrel Loop, Room 227 Langley AFB, VA 23665

DSN 575-2268

COM (757) 225-2268

robert.connolly.3@us.af.mil 633abw.ip@us.af.mil

ACC/IP

162 Dodd Blvd, Ste 115 Langley AFB, VA 23665

DSN 574-2953

COM (757) 764-2953

Acc.ip@us.af.mil mailto:9RW.Information.Protection@us.af.mil mailto:49.FW.InformationProtection@holloman.af.mil mailto:509.BW.IP.Information.Protection@us.af.mil mailto:325fw.ip@us.af.mil mailto:robert.connolly.3@us.af.mil mailto:633abw.ip@us.af.mil mailto:Acc.ip@us.af.mil