TYQ-23A_CLS_DD_FM_254.pdf
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- FA8217-19-R-5003
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CLASSIFICATION (When filled in): Unclassified
PREVIOUS EDITION IS OBSOLETE. Page 1 of 5
AEM LiveCycle Designer DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE. Page 1 of 5
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)
Secret
b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/
MATERIAL REQUIRED AT CONTRACTOR FACILITY
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
FA8217-19-R-5003
DUE DATE (YYYYMMDD)
3. THIS SPECIFICATION IS: (X and complete as applicable.)
a. ORIGINAL (Complete date in all cases.)
DATE (YYYYMMDD)
20190925
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.
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
TBD
b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)
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) Add Row Remove last Row Delete All Rows
a. NAME, ADDRESS, AND ZIP CODE N/A
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.) Add Row Remove last Row Delete All Rows
a. LOCATION(S) (For actual performance, see instructions.)
TBD
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
To provide Sustainment services for the TYQ-23A(V)1(engineering and technical - advisory and assistance services) to support the USAD Control and Reporting Center (CRC) network of systems in multiple locations.
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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.)
SIPRNET Access Required
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.)
The AFFARS clause 5352.204-9000 applies
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)
75 ABW Public Affairs Office, 7981 Georgia Street, Hill AFB, UT 84056 (801-777-5201)
Public Release Authority:
AFIMSC, Public Affairs (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330- 1690
13. SECURITY GUIDANCE Add Signature Remove last Signature Delete All Signatures
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. 10.a: COMSEC safeguarding requirements apply. See the NISPOM chapter 9, section 4 for details. For on-base performance, COMSEC is incumbent on the government. Access on a government installation is granted by the user agency. Access to COMSEC information is restricted to U.S. Citizens holding a final U.S. government clearance at the appropriate level.
Personnel must receive the required COMSEC briefing. Prior approval is required from the Government Contracting Activity prior to granting access to COMSEC information to a subcontractor.
Ref. 10.h.: The contractor is permitted access to Foreign Government Information in performance of this contract. Access to Foreign Government Information requires a valid need- to-know and final U.S. Government clearance at the appropriate level. Prior approval of the contracting activity is required for subcontracting. Refer to the NISPOM chapter 10, section 3 for additional security requirements.
Ref. 10.j.: CUI information provided under this contract shall be safeguarded as specified in DOD Manual 5200.01, Volume 4, DoD Information Security Program: Controlled Unclassified Information (CUI).
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Ref 10.k.: The contractor is permitted access to the Secret Internet Protocol Router Network (SIPRNet). Actual knowledge, generation, or production of NATO information is not required for performance on this contract; however, a NATO awareness briefing will be completed prior to granting access to the SIPRNet.
Ref 11.c.: The contractor requires access to classified source data up to and including SECRET in support of the work effort. All classified information received or generated will be properly stored and handled according to the markings on the material. Contractor will abide by the following security classification guidance: CRC SCG, dated 24 Jul 2019. The applicable SCG will be provided under a separate cover.
At the termination or expiration of this contract, the U.S. Government will be contacted for proper disposition instructions.
Ref. 11.d: The contractor must provide adequate storage for classified hardware and materials to the level of Secret, which exceeds 2 cubic feet and is of size and quantity that it cannot be safeguarded in a General Service Administration (GSA) approved security container.
Ref 11.f.: Overseas contract performance will be at Aviano Italy. A copy of the DD Form 254 must be provided to the AF SSA responsible for overseas inspections and security oversight at the performance location. The Director - Headquarters United States Air Force in Europe will be provided copies of the DD Form 254, as applicable. See the NISPOM, chapter 10 for additional security requirements involving foreign contracts.
Ref 11.g.: The contractor is authorized to use the services of the Defense Technical Information Center (DTIC). The contractor must prepare a DD Form 1540, Registration for Scientific and Technical Information Services, for GCA submittal. The contractor may submit a DD Form 2345, Military Critical Technical Data Agreement, (after registration with DTIC) to the Defense Logistics Services Center for access to unclassified, militarily critical technical data from other DoD sources. Reference the NISPOM chapter 11, section 2 for preparation of these forms. The GCA must be involved in certifying need-to-know for contractors to utilize DTIC.
Ref 11.h.: A COMSEC account will be established and COMSEC will be protected per the NISPOM chapter 9, section 4.
Ref 11.k. This contract requires the use of the Defense Courier Service (DCS). The government contracting activity will request written approval for DCS services from the Commander, Defense Courier Service, ATTN: Operations Division, United States Transportation Command, 508 Scott Drive, Scott Air Force Base, IL 62225. Prior approval is required from the contracting activity, prior to authorizing a subcontractor to utilized DCS services.
Ref 11.l. In accordance with DFARS Subpart 252.204-7012, contractors and subcontractors will safeguard covered defense information that resides in or transits through contractor information systems by applying specified network security controls, and will report cyber incidents.
Ref 11.m. The contractor is designated as an Integrated Visitor Group and will provide the Servicing Security Activity, listed in Item 15 “Ref: 8.a”, with all the information required by the Air Force Federal Acquisition Regulation Supplement (AFFARS) 5352.204-9000, Notification of Government Security Activity and Visitor Group Security Agreements clause at least 30 days prior to beginning operations on Hill AFB. Contractors will not begin operations on Hill AFB until a Visitor Group Security Agreement has been signed.
Ref 18.d: A signed copy of this DD FM 254 must be provided to: (specify all the applicable Director/s for Information Protection address or addresses for country or countries where performance will occur. Addresses are listed below:)
List of Attachments [1] (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form)
Add Attachment View Selected Attachment Remove Selected Attachment
NAME & TITLE OF REVIEWING OFFICIAL
Program Manager
SIGNATURE
NAME & TITLE OF REVIEWING OFFICIAL
Theodore R. Yost III, AFLCMC, Division Chief Information Protection
SIGNATURE
NAME & TITLE OF REVIEWING OFFICIAL
Lori A. Prendergast, 75 ABW/SCXS, Base COMSEC/TEMPEST Manager
SIGNATURE
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NAME & TITLE OF REVIEWING OFFICIAL
Amie Satterfield, AFLCMC/WFNH, Foreign Disclosure Office
SIGNATURE
NAME & TITLE OF REVIEWING OFFICIAL
Steven G. Nutt, 75 ABW/IP, Industrial Security Specialist
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.)
Ref 11.f.: Disclosure of information related to this contract to citizens, or representatives, of multiple countries shall be in accordance with DoDD 5230.11 and the most current version of the applicable Delegation of Disclosure Letter.
Ref 11.j. The contractor must comply with the U.S. Government, DOD, Air Force, AFMC, Hill AFB, and AFLCMC/HBZ Operation Security (OPSEC) Programs. The contractor must comply with any additional OPSEC requirements referenced in attachment within Item 13.
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.)
Ref. 8.a.: The Defense Security Services (DSS) is relieved of all industrial security review responsibilities for contractor performance on the government installation identified in Item 8.a. The SSA, 75 ABW/IPD 7981 Georgia Street, HAFB, UT 84056: steven.nutt.2@us.af.mil) has exclusive oversight responsibilities while operating on the installation.
16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)
a. GCA NAME
Same as Item 17
b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)
c. ADDRESS (Include ZIP Code) d. POC NAME
e. POC TELEPHONE (Include Area Code)
f. EMAIL ADDRESS (See Instructions)
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)
Farley, Wendy
b. TITLE
Contracting Officer
c. ADDRESS (Include ZIP Code)
AFLCMC/PZZKB
6039 Wardleigh Rd Hill AFB, UT 84056-5819
d. AAC OF THE CONTRACTING OFFICE (See Instructions)
FA8217
e. CAGE CODE OF THE PRIME CONTRACTOR
(See Instructions.)
N/A
f. TELEPHONE (Include Area Code)
+1 (801) 586-3464
g. EMAIL ADDRESS (See Instructions)
h. SIGNATURE
i. DATE SIGNED (See Instructions)
20191007
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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.)
75 ABW/IPD: 7981 Georgia Street, HAFB, UT 84056:
(steven.nutt.2@us.af.mil)
Attachment OPSEC Requirements, Cubic Defense Applications
Solicitation Number FA8210-19-R-5000
Reference: National Security Decision Directive (NSDD) 298
DOD 5205.02
DODD 5205.02E
AFI10-701AFGM_2018-01
All contractors, subcontractors, their employees, associates, and consultants who have access to critical information must comply with the DOD and Air Force-sponsored Operations Security (OPSEC) program. The OPSEC Program is directed by NSDD298, DOD Publications, and applicable Air Force guidance.
OPSEC is a systematic means of identifying and protecting information which an adversary could use to their advantage or to our disadvantage. Critical Information (CI) is generally unclassified but can become classified through compilation. This sensitive information has been identified by the organization’s OPSEC program as requiring protection. OPSEC Measures (OM) are control standards with which all personnel must comply in order to protect CI against adversaries.
RESPONSIBILITIES:
The Air Force Life Cycle Management Center (AFLCMC) OPSEC Program Coordinator Mr. Theodore Yost, NH-03 will provide / approve OPSEC training curriculum for use by the contractor. Critical Information and Indicator Listings (CIILs) must be protected by all contract personnel. Approved organizational OPSEC measures must be used by all contract personnel to protect critical information in their possession and protect against current foreign intelligence and industrial espionage threats. The OPSEC PM/Coordinator and the Lead contractor must ensure all contract personnel working on the contract or having access to CI attend initial and annually recurring refresher training and that the approved curriculum is presented. Training must be provided before contract personnel are allowed access to or handling of critical information. All contract personnel will comply with the organizations OPSEC standards and practices as trained. Additional training may be required based on updates to critical information, OPSEC measures, intelligence threat/vulnerability, or other fundamental changes to the OPSEC program. The OPSEC Coordinator is responsible for contacting the OPSEC Program Manager if OPSEC isn’t written into the contract.
The OPSEC PM/Coordinator for the organization will track OPSEC training statistics for all personnel working on the contract, when each individual has received the required OPSEC training, and when refresher training is due. Training statistics must be forwarded to the installation OPSEC PM at the end of each calendar quarter and/or upon request.
Contactors with OPSEC requirements within a contract must ensure employees receive OPSEC training as specified within the contract. Accomplishment of training must not exceed 90 days from initial assignment to a contract with OPSEC requirements. Annual training will be accomplished NLT 30 September of each year. The contractor personnel will not be given access to an organizations CIIL until after training has been completed and documented by the organization OPSEC Coordinator.
Prior to seeking approval through Hill AFB Public Affairs, any information to be released outside of official U.S. Government channels, via any media, must be approved through an OPSEC review by the AFLCMC PM/Coordinator. All personnel must promptly report OPSEC related incidents, issues, and concerns to the AFLCMC PM/Coordinator, who will then report it to the installation PM, 801-586-8008.
Solicitation #: FA8217-19-R-5003
DRAFT
SAMPLE
PREVIOUS EDITION IS OBSOLETE.
Page of AEM LiveCycle Designer
DD FORM 254, APR 2018
NEEDS DD67
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
2. THIS SPECIFICATION IS FOR: (X and complete as applicable.)
3. THIS SPECIFICATION IS: (X and complete as applicable.)
a. ORIGINAL (Complete date in all cases.)
b. REVISED (Supersedes all previous specifications.)
4. IS THIS A FOLLOW-ON CONTRACT?
If yes, complete the following:
Classified material received or generated under
5. IS THIS A FINAL DD FORM 254?
If yes, complete the following:
6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code)
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)
8. ACTUAL PERFORMANCE (Click button to add more locations.)
10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)
e. NATIONAL INTELLIGENCE INFORMATION:
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.)
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)
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.)
14. ADDITIONAL SECURITY REQUIREMENTS
Requirements, in addition to NISPOM requirements for classified information, 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 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.)
15. INSPECTIONS
Elements of this contract are outside the inspection responsibility of the CSO.
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.)
16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)
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.
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL
9.0.0.2.20120627.2.874785 DD 254, DoD Contract Security Classification Specification List of Attachments [1] (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form) Attachment OPSEC Requirements.docx
| CurrentPage: |
| PageCount: |
| Classification: Unclassified |
| SerialNum: |
| a. Facility clearance level. Select one.: 2 |
| b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 2 |
| Choose Yes or No: 0 |
| Choose Yes or No: 1 |
| Prime: |
| Choose Yes or No: 0 |
| Choose Yes or No: 0 |
| Sub: |
| Choose Yes or No: 1 |
| Choose Yes or No: 0 |
| Soli: FA8217-19-R-5003 |
| DueDate: |
| dateA: 20190925 |
| RevisionNum: |
| dateB: |
| Final: |
| dateC: |
| No: 1 |
| No: 1 |
| No: 0 |
| No: 0 |
| Yes: 0 |
| Yes: 0 |
| Yes: 1 |
| Yes: 1 |
| Enter your name here.: |
| ReqDated: |
| Enter your name here.: |
| Name: TBD |
| Name: N/A |
| Name: Farley, Wendy |
| Cage: N/A |
| CSO: |
| addrow: |
| Removerow: |
| Click to delete a row: |
| Location: TBD |
| Block9: To provide Sustainment services for the TYQ-23A(V)1(engineering and technical - advisory and assistance services) to support the USAD Control and Reporting Center (CRC) network of systems in multiple locations. |
| a: 1 |
| a: 0 |
| a: 1 |
| f: 0 |
| f: 1 |
| f: 1 |
| b: 0 |
| b: 0 |
| b: 0 |
| g: 0 |
| g: 1 |
| c: 0 |
| c: 1 |
| c: 1 |
| h: 1 |
| h: 1 |
| d: 0 |
| d: 1 |
| d: 1 |
| i: 0 |
| i: 0 |
| SCI: 0 |
| NonSCI: 0 |
| j: 1 |
| j: 1 |
| k: 1 |
| k: 1 |
| Enter your name here.: SIPRNET Access Required |
| Enter your name here.: The AFFARS clause 5352.204-9000 applies |
| Enter your name here.: 75 ABW/IPD: 7981 Georgia Street, HAFB, UT 84056: (steven.nutt.2@us.af.mil) |
| e: 0 |
| e: 0 |
| l: 1 |
| m: 1 |
| direct: 0 |
| thru: 1 |
| Enter your name here.: 75 ABW Public Affairs Office, 7981 Georgia Street, Hill AFB, UT 84056 (801-777-5201) |
| PublicAuthority: AFIMSC, Public Affairs (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330- 1690 |
| AddSig: |
| RemoveSig: |
| text: Ref. 10.a: COMSEC safeguarding requirements apply. See the NISPOM chapter 9, section 4 for details. For on-base performance, COMSEC is incumbent on the government. Access on a government installation is granted by the user agency. Access to COMSEC information is restricted to U.S. Citizens holding a final U.S. government clearance at the appropriate level. |
Personnel must receive the required COMSEC briefing. Prior approval is required from the Government Contracting Activity prior to granting access to COMSEC information to a subcontractor.
Ref. 10.h.: The contractor is permitted access to Foreign Government Information in performance of this contract. Access to Foreign Government Information requires a valid need- to-know and final U.S. Government clearance at the appropriate level. Prior approval of the contracting activity is required for subcontracting. Refer to the NISPOM chapter 10, section 3 for additional security requirements.
Ref. 10.j.: CUI information provided under this contract shall be safeguarded as specified in DOD Manual 5200.01, Volume 4, DoD Information Security Program: Controlled Unclassified Information (CUI).
Ref 10.k.: The contractor is permitted access to the Secret Internet Protocol Router Network (SIPRNet). Actual knowledge, generation, or production of NATO information is not required for performance on this contract; however, a NATO awareness briefing will be completed prior to granting access to the SIPRNet.
Ref 11.c.: The contractor requires access to classified source data up to and including SECRET in support of the work effort. All classified information received or generated will be properly stored and handled according to the markings on the material. Contractor will abide by the following security classification guidance: CRC SCG, dated 24 Jul 2019. The applicable SCG will be provided under a separate cover. At the termination or expiration of this contract, the U.S. Government will be contacted for proper disposition instructions.
Ref. 11.d: The contractor must provide adequate storage for classified hardware and materials to the level of Secret, which exceeds 2 cubic feet and is of size and quantity that it cannot be safeguarded in a General Service Administration (GSA) approved security container.
Ref 11.f.: Overseas contract performance will be at Aviano Italy. A copy of the DD Form 254 must be provided to the AF SSA responsible for overseas inspections and security oversight at the performance location. The Director - Headquarters United States Air Force in Europe will be provided copies of the DD Form 254, as applicable. See the NISPOM, chapter 10 for additional security requirements involving foreign contracts.
Ref 11.g.: The contractor is authorized to use the services of the Defense Technical Information Center (DTIC). The contractor must prepare a DD Form 1540, Registration for Scientific and Technical Information Services, for GCA submittal. The contractor may submit a DD Form 2345, Military Critical Technical Data Agreement, (after registration with DTIC) to the Defense Logistics Services Center for access to unclassified, militarily critical technical data from other DoD sources. Reference the NISPOM chapter 11, section 2 for preparation of these forms. The GCA must be involved in certifying need-to-know for contractors to utilize DTIC.
Ref 11.h.: A COMSEC account will be established and COMSEC will be protected per the NISPOM chapter 9, section 4.
Ref 11.k. This contract requires the use of the Defense Courier Service (DCS). The government contracting activity will request written approval for DCS services from the Commander, Defense Courier Service, ATTN: Operations Division, United States Transportation Command, 508 Scott Drive, Scott Air Force Base, IL 62225. Prior approval is required from the contracting activity, prior to authorizing a subcontractor to utilized DCS services.
Ref 11.l. In accordance with DFARS Subpart 252.204-7012, contractors and subcontractors will safeguard covered defense information that resides in or transits through contractor information systems by applying specified network security controls, and will report cyber incidents.
Ref 11.m. The contractor is designated as an Integrated Visitor Group and will provide the Servicing Security Activity, listed in Item 15 “Ref: 8.a”, with all the information required by the Air Force Federal Acquisition Regulation Supplement (AFFARS) 5352.204-9000, Notification of Government Security Activity and Visitor Group Security Agreements clause at least 30 days prior to beginning operations on Hill AFB. Contractors will not begin operations on Hill AFB until a Visitor Group Security Agreement has been signed.
Ref 18.d: A signed copy of this DD FM 254 must be provided to: (specify all the applicable Director/s for Information Protection address or addresses for country or countries where performance will occur. Addresses are listed below:)
| attachmentsList: |
| AddAttachment: |
| ViewAttachment: |
| RemoveAttachment: |
| rep: Program Manager |
| rep: Theodore R. Yost III, AFLCMC, Division Chief Information Protection |
| rep: Lori A. Prendergast, 75 ABW/SCXS, Base COMSEC/TEMPEST Manager |
| rep: Amie Satterfield, AFLCMC/WFNH, Foreign Disclosure Office |
| rep: Steven G. Nutt, 75 ABW/IP, Industrial Security Specialist |
| Sig: |
| Enter your name here.: Ref 11.f.: Disclosure of information related to this contract to citizens, or representatives, of multiple countries shall be in accordance with DoDD 5230.11 and the most current version of the applicable Delegation of Disclosure Letter. |
Ref 11.j. The contractor must comply with the U.S. Government, DOD, Air Force, AFMC, Hill AFB, and AFLCMC/HBZ Operation Security (OPSEC) Programs. The contractor must comply with any additional OPSEC requirements referenced in attachment within Item 13.
| Enter your name here.: Ref. 8.a.: The Defense Security Services (DSS) is relieved of all industrial security review responsibilities for contractor performance on the government installation identified in Item 8.a. The SSA, 75 ABW/IPD 7981 Georgia Street, HAFB, UT 84056: steven.nutt.2@us.af.mil) has exclusive oversight responsibilities while operating on the installation. |
| GCAName: Same as Item 17 |
| AAC: FA8217 |
| Address: AFLCMC/PZZKB |
6039 Wardleigh Rd Hill AFB, UT 84056-5819
| POCName: |
| Phone: 8015863464 |
| Email: |
| Title: Contracting Officer |
| Enter the date using the format DD-Mon-YYYY: 20191007 |
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