ATTACHMENT_08_A-10_DD254.pdf

1. CLEARANCE AND SAFEGUARDING

DEPARTMENT DF DEFENSE ' FACILITY CLEARANCE REQUIRED

CONTRACT SECURITY CLASSIFICATION SPECIFICA TIDN Secret (The requirements of the OoD Industrial Security Manual apply

b. LEVEL OF SAFEGUARDING REQUIRED to all seculity aspects of this efforl.)

None

2. THIS SPECIFICATION IS FOR: (X and comp/ate as appNcable) J. THIS SPECIFICATION rs: (X and comp/ala as epp/icable)

' PRIME CONTRACT NUMBER x DATE (YYYYMMDD)

'· ORIGINAL (Complete date in all cases;

20161013

' SUBCONTRACT NUMBER 0. REVISED ! REVISION NO. DATE (YYYYMMDD)

(Supersedes a/I previous specs) x '· SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMDD) DATE (YYYYMMDD)

FA8220-l 7-R-0001 20160126 ' FINAL (Complete I/em 5 in al/ cases)

4. IS THIS A FOLLOW-ON CONTRACT? l_JYES L_XjNO. 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? L_jYES L_XjNO. If Yes, complete the following:

In response to the contracio~s request dated , retention of the classified material is author/zed for the period of

6. CONTRACTOR (/nr::Jude Commerc:ia/ end Government Entity (CAGE) Code)

'· NAME, ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Cocle)

Raytheon Company 06845 J)efense Security Service (IOFCLI)

6260 Guardian Gateway 7556 Teague Road, Ste. 580

Aberdeen Proving Ground, MD 21005 Hanover MD 21076

7. SUBCONTRACTOR

a. NAME. ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Coda)

NIA NIA NIA

8. ACTUALPERFORMANCE .. LOCATION b. CAGE CODE c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code)

See Blk 13 NIA See Blk 13

9. GENERAL IDENTIFICATION OF THIS PROCUREMENT

Contractor engineering support for the A-10 APX-119 ADS-B and Mode 5 development effort.

10. CONTRACTOR WILL REQUIRE ACCESS TO: VOS NO 11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL: YES NO

' COMMUNICATIONS SECURITY (COMSEC) INFORMATION x ' 00Nl~8f6~·s -r-Aefrlf\1 oR i(NJ°OVERAJklfo~ ... Abt1tTT~· ·- HER x

b. RESTRICTED DATA x • RECEIVE CLASSIFIED DOCUMENTS ONLY x ' CRITICAL NUCLEAR WEAPON DESIGN INFORMATION x ' RECEIVE AND GENERATE CLASSIFIED MATERIAL x ' FORMERLY RESTRICTED DATA x ' FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE x .. INTELLIGENCE INFORMATION , .•.. • PERFORM SERVlCES ONLY x

(1) se.,.ibve Compa~mentad Information (SCI) x f ~¥r.AGqf)k TO U~i!ts~IF~§' JN OR~u'1NO•>iOM ®DE 1HE -·--. P RTO RI , U.S. E SION AND TRU TER IT RIES x

(2) NOO·SCI x " ~~tftUJ~?J'fr-"h~ooWi~~'$~g5.1 ... ·Pif~ [ IST-FiiBD~fJN· ""Em1~<tL INFORMA 1-. x

' SPECIAL ACCESS INFORMATION x h. REQUIRE A COMSEC ACCOUNT x

g. NATO INFORMATION x ; HAVE TEMPEST REQUIREMENTS x

" FOREIGN GOVERNMENT INFORMATION x I HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS x ; LIMITED DISSEMINATION INFORMATION x k. BE AUTHORIZED TO USE THE DEFENSE COURIER SERVICE x J. FOR OFFICIAL USE ONLY INFORMATION x L OTHER (Specify) x

k. OTHER (Specify} x Access to all A-10 facilities and aircraft where KIV-77 c1yptographic devices ~·ith codes loaded are installed and active. TI1eAFFARS clause 5352.204-9000 applies.

DD FORM 254, DEC 1999 PREVIOUS EDITION rs OBSOLETE. Adoba Professtonal 7.0

12. PUBLIC RELEASE. Any information (classified or unclassified) pertaining to this contract shall not trn released for public dissemination except as provided by the Industrial Security Manual or unless ii has been approved for public release by appropriate U.S. Government authority. Proposed public releases shall be submitted for approval prior to release [fil Direct [==i Through (Specify)

Requests shall be made to Mr. Christopher Suinmer:s ADS-B Project Manager, A-IO Avionics

6067 Box Elder Lane, Bldg. 1284

Hill AFB, UT 84056 to the Directorate for Freedom of Information and Security Review, Office of the Assistant secretary of Defense (PubJic Affairs)" for review.

•1n the case of non-DoD user Agencies, requests tor disclosure shall be submitted to that agency.

13. SECURITY GUIDANCE. The secur~y classification guidance needed forth is ciassified effort ls identified below. If any difficulty is encountered in applying this guidance or if any other conbibuting factor indicates a nee-0 for changes in this guidance, the contractor is authorized and encouraged lo provide recommended changes; to diallenge the guidance or the class'1fication assigned to any information or material furnished or generated under this contract: and to submit any questions for interpretation of this guidance lo the offlclal ident~;,,d 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 documen/s/guideslextracts referenced herein. Add addittonal pages as naec/ed to provide comp/eta guidanca.)

Ref. 8,a.; AFLCMC/WW A Ref. 8.c.: 75 ABW/IPD

6067 Box Elder Lane 798 l Georgia Street (Bldg I I 02)

Hill AFB UT 84056 Hill AFB UT 84056

Ref. 8.a.: 59TES/DOT Ref. 8.c.: 99 ABW/IP

76257 Bale A venue 431 l Carswell Ave, suite 205

Nellis AFB NV 89191 Nellis AFB NV 89191

Ref. 8.a.: 40th Flight Test Squadron/OL-A Ref. 8.c.: 162 FW/IP

3900 S 5th Street 1650 E. Perimeter Way

Bldg 5410 Tucson, AZ 85706

Tucson, AZ 85707

Ref. 8.a: 40th Flight Test Squadron Ref. 8.c.: 496 TW/IP

505 W. Choctawhatchee Ave. 101 West Dave Ste 14

Suite 246, Bldg 64 Eglin AFB, FL 32542

Eglin AFB, FL 32542

See Continuation Sheet for additional infom1ation.

14. ADDITIONAL SECURITY REQUIREMENTS. Requirements. in add~ion to ISM requ;rements, are established for this contract .. l1SJ Yes LJ No (If Yes, identify the pertinent contractual clauses in the-contract document itself, or provide an appropriate statement which idantifies the additional requirements_ Provide a e-0py of the requirements to the cognizant sacwity office_ Use Item 13 if edd~iona/ space Is needed-)

For pcrfonnance on a government installations, the contractor will provide the information requested by the Notification of Government Security Activity and Visitor Group Security Agree1ncnts Clause, Air Force Federal Acquisition Regulation Supplement 5352.204-9000, to the Servicing Security Activity addresses listed in 8.c. (131ock 13) at least 30 days prior to beginning operations. Refer to AFFARS Addendum for this clause.

15. INSPECTIONS. Elements of this contract are outside the inspecf1on responsibility of the cogni~ant security office. _~Yes , LJ No (If Yes, explain and idantify specific areas or elements carved out and the activity responsible for inspections. Use Item 13 if additional space 1s needed.)

The Defense Security Services (DSS) is relieved of all industrial security revie\V responsibilities filr contractor performance on government installations identified in Items 8.a. The SSAs, Identified in Items 8.c have exclusive oversight responsibilities \vhile operating on the Air Force Installations.

16. CERTIFICATION AND SIGNATURE. Security requirements stated herein are complete and adequate for safeguarding the classified infonnation to be released or generated under this classified effort Alf questions shall be referred to the official named below.

a. TYPED NAME OF CERTIFYING OFFICIAL b. TITLE ' TELEPHONE (Include Area Code)

Chad Galioto Contracting Officer (801) 586-0690

d. ADDRESS (Include Zip Code) 17. REQUIRED DISTRIBUTION AFLCMC/WLDKA x a. CONTRACTOR 6072 Fir Avenue, Bldg 1233 ~

b. SUBCONTRACTOR Hill AFB, UT. 84056 x c COGNIZANT SECURITY OFFICE FOR PRIME ANO SUBCONTRACTOR

e. SIGNATURE f

;o/t:;-/;b

d. US. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION

C:.,I • ~ x e ADMINISTRATIVE CONTRACTING OFFICER x f. OTHERS AS NECESSARY !P Offices identified in Bio-ck 13 Item 8.c A f

DD rvRM 254 (BACK), DEC 1999 r I

Department of Defense Contract Security Classification Specification

Block 13 Continued

DD Form 254(Block131 Continuation Sheet) Prime Contract No.

FA8220-17-R-0001

21 September 2016

Ref. 10.a.: Contractors will conduct maintenance troubleshooting activities on equipment that could have cryptographic gear loaded.

Ref. 10.j.: FOUO 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. 11.a.: Contract performance is restricted to locations identified in Block 13 Items 8.a - 8.c. The contract activities at these locations have been provided security classification guidance for performance of this contract.

Ref. 11.j.: The contractor must comply with U.S. Government, DoD, Air Force, Hill AFB, Davis Monthan

AFB, Eglin AFB and Nellis AFB, AFLCMC Operation Security (OPSEC) Programs. OPSEC requirements are referenced in the OPSEC DD254 Addendum attached. The contractor must comply with all additional

OPSEC requirements referenced.

SECTION3

SAMPLE DD FORM 254 ADDENDUMS

AFFARS 5352.204-9000. NOTIFICATION OF GOVERNMENT SECURITY ACTMTY AND

VISITOR GROIJP SECJTRITY AGREEMENTS (APR 2003) ADDENDIJM

FA8220-17-R-OOOI

1. This contract contains a f)D Form 254, DOD Contract Security Classification Specification, and requires performance at a government location in the U.S. or overseas. Prior to beginning operations involving classified infonnation on an installation identified on the DD Fann 254, the contractor shall take the following actions:

a. At least 30 days prior to beginning operations, notify the Cognizant Security Office/s (IP Office/s) shown in block 8.c and Program Manager sho\vn in block 13 of the DD Fann 254 as to:

(1) The name, address, and telephone nu1nber of this contract company's representative and designated alternate in the U.S. or overseas area, as appropriate;

(2) The contract number;

(3) The highest classification category of defense information to which contractor employees will have access;

(4) The Air Force installations in the U.S. (in overseas areas, identify only the APO number(s)) where the contract work will be perfonned;

(5) The date contractor operations will begin on base in the U.S. or in the overseas area;

(6) The estimated completion date of operations on base in the U.S. or in the overseas area; and,

(7) Any changes to infonnation previously provided under this clause.

This requirement is in addition to visit request procedures contained in DOD 5220.22-M, National Industrial Security Program Operating Manual.

b. Prior to beginning operations involving classified infonnation on an installation identified on the DD Fann 254 where the contractor is not required to have a cleared facility, the contractor shall enter into a Visitor Group Security Agreement (or understanding) with the installation commander to ensure that the contractor's security procedures are properly integrated with those of the installation. As a mini1num, the agreement shall identify the security actions that will be perfonned:

(1) By the installation for the contractor, such as providing storage and classified reproduction facilities, guard services, security forms, security inspections under DOD 5220.22-M, classified mail services, security badges, visitor control, and investigating security incidents; and

(2) Jointly by the contractor and the installation, such as packaging and addressing classified transmittals, security checks, internal security controls, and implementing emergency procedures to protect classified material.

DD Form 254 Attachment

OPS EC

All contractors, subcontractors, their employees, associates, and consultants who l1ave access to critical information must comply with the Air Force-sponsored Operations Security (OPSEC) program.

OPS EC 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 Wlclassified but sensitive information which I1as been identified bytl1e OPSEC program as requiring protection. OPSEC Measures (O.M) are control standards \Vith which all personnel must comply in order to protect critical infonnation.

Responsibilities:

The Air Force Life Cycle Logistics Center (AFLCMC) OPSEC must provide I approve OPSEC training curriculum for use by the contractor. Training must provide listings of critical information that must be protected by all personnel, listings of OPSEC measures which inust be used by all personnel to protect critical information, and current foreign intelligence and industrial espionage threats. The contractor must ensure all personnel working on the contract or having access to critical information attend initial and annually recurring refresher training and that the approved curriculum is presented. Training must be provided before personnel are allowed access to critical infonnation. All personnel must comply with OPSEC standards and practices as trained. Additional training may be required based on updates to critical information, OPSEC measures, intelligence threat, or other fundamental changes to the OPSEC program.

The contractor must track OPSEC training statistics to include the personnel working on the contract, when each individual received the required OPSEC training, and when refresher training is due. Training statistics must be forwarded to Air Force Life Cycle Logistics Center (AFLCMC) OPSEC Program Manager at the end of each calendar year and upon request.

Prior to seeking approval through Hill AFB Public Affairs, any information to be released outside of official U.S. Governme11t channels, via any media, must be approved tlrrough an OPSEC review by OPSEC Program Manager. All personnel must promptly report OPSEC related incidents, issues, and concerns to Air Force Life Cycle Logistics Center (AFLCMC) OPSEC Program Manager at (801) 586-3194.

Prime Contract or Solicitation#: F A8220-17-R-0001