Attachment_4_DD254.pdf

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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PREVIOUS EDITION IS OBSOLETE.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 (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form)

2340 Dulles Corner Blvd.

Herndon, VA 20171

13873 Park Center Road, Suite 225 Herndon, VA 20171

(571) 373-5205

1899 Powers Ferry Road, Suite 330 Atlanta, GA 30339

(770) 370-3740

101 Industrial Park Blvd.

Warner Robins, GA 31088 Location: Electronic Warfare Avionics Integration Support Facility 235 Byron St., Suite 19A Robins AFB GA 31028 See Blk 13

Robins AFB GA 31098 2145 Monahan Way, Bldg.28 Attn: Daniel Gelter Wright Patterson AFB, OH Attn: Kenneth Keyes 45433

Ref Blk 10j: See DoDM 5200.01, Volume 4, DoD Information Security Program: Controlled Unclassified Information (CUI), Enclosures 3 & 4 and DoDM 5400.07/ Air Force Manual 33-302, DoD Freedom of Information Act (FOIA) Program, and AFI 16-1404, Air Force Information Security Program, for requirements.

Ref Blk 11c: Any classified information generated in the performance of this contract shall require the contractor to apply derivative classification and markings consistent with the source material.

AN/ALQ-155 Power Management System Including AN/ALT-28 (V) Transmitting Set, AN/ALT 13 (V) Transmitting Set Security Classification Guide dated 2 November 2011 / Intermittent use of on base Lab for testing.

Ref Blk 11d: The contractor is required to provide adequate and approved storage for classified hardware or material to the level of Secret which because of size or quantity cannot be safeguarded in an approved storage container.

Ref Blk 11j: OPSEC requirements apply. See Statement of Work (SOW) for requirements.

Ref Blk 12: Information requiring AF or DoD-level review will be forwarded by the entry-level public affairs office through the AFIMSC Public Affairs Office to the Secretary of the Air Force, Office of Public Affairs, Security and Review Division (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330-1690. MAJCOM/DRUs will send information requiring AF or DoD-level review directly to SAF/PAX.

AFSC/AFLCMC/WNKD

235 Byron St Suite 19A Robins AFB GA 31098

Transmission of public release request via e-mail is not authorized.

The Contractor shall notify the Government Contracting Activity and the Government Security Manager within 24 hours of any incident involving the actual or suspected compromise/loss of classified information to enable the Government to conduct immediate assessments of potential impact pending formal inquiry/investigation. Actual or suspected compromise of Covered Defense Information will be reported IAW DFARS Clause 252.204-7012

AFLCMC/WNKD

rep: Jucal Higgs-Bradford, DAF Security Specialist rep: Sean Crone, DAF Industrial / Information Security Protection

235 Byron St Suite 19A Robins AFB GA 31098 Address: AFSC/AFLCMC/WNKD 235 Byron St Suite 19A Robins AFB GA 31098