Atch_4_DD254_with_Attachments.pdf

CLASSIFICATION (�en filled in): Unclassified

SSO Patrick NAME & TITLE OF REVIEWING OFFICIAL cdlt :J II', Irr, /J?t' /h ;vL, C Ii ,·<r..f', 5o

ISPM NAME & TITLE OF REVIEWING OFFICIAL

C}o. .A� -/<ti 1-{c s -rs,. /fJ( fiff /tC. )

Information Assurnncc ¥ NAME& TITLE OF REVIEWING OFA

ATURE

/J' //.) vt -Y.lj:y ti 5 O v-v L.-

- \.fl/·- �

14. ADDITIONAL SECURITY REQUIREMENTS ., �

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

0No [8] Yes If Yes. identify the pertinent contrar:tual clauses in the contract document itself. or provide an appropriate statement which idenMes the additional reqvirtments. Provide II copy of the requlrtmtnts to the CSO. The lfeld w,11 expand as tell Is added or you can also use item 13. When rtmovin9 any expand� text arta. use delete key or backspace ley. then click out of the text �eld for It to shrink a/fer the text has been detet� (See lnstlVdions for additional gindance or use of the fillabla PDF.)

Sec atlachmcnt for Release ufSCI lntelligcncc/Non-lntelligence lnfonnation ( 10.e. I .2) for additional security requirements. l'ril1r appro\'al of the contracting activity is rcquin.'d for subcontracting. All 01> FMs 254 prepared for a sulx:onlmct hy the prime contract will be forwarded lo the government contracting monitor and SSO Patrick for review and concurrence prior to award of the subcontmet. Access to intelligence infonnation will require special briefings and final U.S. Go\'emment Top Secret clearance with ICD 704 eligibility.

( IF CONTRACTORS WORK IN AFTAC FOR 90 CONSECUTIVE DA VS. A VISITOR GROUP SECURITY 1\GREEMENT (VGS/\)

MUST BE ADDED TO CONTRACT. VGSA IS LOCATED IN TIIE SR I.IB/\RY)

15. INSPECTIONS

Elements of this contract are outside the inspedion responsibility of the cso.

0No [81 Yes If Yes. e•plain and ldflntity spec;fic areas and government activity msponslble for inspections. � �eld ,..;u e•pand as led is added or you can also use item

13. �M removint; any expanded text 11rt1. use delet" key or bacJcspace l<ey. then clicl< out oft� tel/ t!etd for II to shrink a/fer the te•t has been deleted.

(See instructions for 11dditional gindance or use of the (ii/able PDF.)

SSO Patrick has exclusive security responsibility for all SCI classified material relca.�ed to nr developed under this contrnct and held at the government SCI facility and/or the contmctor's SCI facility. Defense SL"Curity Service retains cogni,.ancc only O\'Cr non-SCI material released to or developed under the contrJct and held within the cuntrnctor"s SCI facility or cleared facility.

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

c. ADDRESS (lndude ZIP Code) d.POC NAME a.GCA NAME

Amy Schultz

e. POC TELEPHONE (Include Aft'a Code}

b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See lnstrvctionsJ f. EMAIL ADDRESS (See lnslrvclionsJ

FA7022

17. CERTIFICATION AND SIGNATURES

. Security requirements stated herein are complete and adequate for safeguarding the dassified Information to be released or generated under this dassified 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 lod\ed.

a. TYPED NAME OF CERTIFYING OFFICIAL (Last. First. Middle Initial} d. AAC OF THE CONTRACTING OFFICE

(See Instructions) (See lnstrvctions)

Lori Greene F/\7022

b. TITLE e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions}

c. ADDRESS (lndude ZIP Code) f. TELEPHONE (lndude An!a Code)

g. EMAIL ADDRESS (See lnstrvctionsJ

DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE.

CLASSIFICATION (\Mien filled in): Uncla.�sili�'tl

h. SIGNATURE

I. DATE SIGNED

(See Instructions)

AEM I.MCyde Ocsigr't>f

Contracting Officer

1020 S. Patrick Drive Patrick AFB, FL .32925