Attach_12-_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PREVIOUS EDITION IS OBSOLETE.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)

Bldg. 8400 – North, Room 114 5316 S. Douglas Blvd., Oklahoma City, OK 73150

(405) 582-1610, DSN 852-1610

CSO: AFLCMC/LZPEM

7851 Arnold Ave, Building 3, Room 213 Tinker AFB, OK 73145

DSN 336-2227 COMM 405-736-2227

CSO: 78 ABW/IP

985 Macon Street Robins AFB GA 31098

(478) 222-1977, DSN 472-1977

CSO: 8 ABW/IP

985 Macon Street Robins AFB GA 31098

(478) 222-1977, DSN 472-1977

CSO: 78 ABW/IP

985 Macon Street Robins AFB GA 31098

(478) 222-1977, DSN 472-1977

CSO: 78 ABW/IP

985 Macon Street Robins AFB GA 31098

(478) 222-1977, DSN 472-1977

CSO: 78 ABW/IP

985 Macon Street Robins AFB GA 31098

(478) 222-1977, DSN 472-1977

CSO: 78 ABW/IP

985 Macon Street Robins AFB GA 31098

(478) 222-1977, DSN 472-1977

CSO: 78 ABW/IP

985 Macon Street Robins AFB GA 31098

(478) 222-1977, DSN 472-1977

CSO: 78 ABW/IP

985 Macon Street Robins AFB GA 31098

(478) 222-1977, DSN 472-1977

CSO: 78 ABW/IP

985 Macon Street Robins AFB GA 31098

(478) 222-1977, DSN 472-1977

3001 Staff Drive, Bldg. 3001 Tinker AFB OK 73145 Secret Location: AFLCMC/LZPT 7851 Arnold Ave, Bldg. 3, Room 205 Tinker AFB, OK 73145 Secret Location: AFLCMC/WLS 235 Byron Street, Suite 19A Bldg. 300 WW, Bay B Robins AFB, GA 31098-1670 Secret Location: AFLCMC/WWQ 235 Byron Street Bldg. 300 EW, Bay H Robins AFB, GA 31098-1670 Secret Location: AFLCMC/LZPT 235 Byron Street Bldg. 300 WW, Bay C Robins AFB, GA 31098-1670 Secret Location: AFLCMC/WIUAH 235 Byron Street, Suite 19A Bldg. 300, Head-house, Bay A Robins AFB, GA. 31098-1670 Secret Location: AFLCMC/LZPT 280 Byron Street Bldg. 229, 1st, 2nd, and 3rd floors Robins AFB, GA. 31098-1670 Secret Location: 402 EMXG; 566 EMXSS; 568 EMXSS; 569 EMXSS Page Road, Building 640/645 Bldgs. 640/645 Robins AFB, GA 31098-1640 Secret Location: 561st AMXG Hercules Street, Bldg. 20028; 1st floor in supervisors office Robins AFB, GA 31098-1640 Secret Location: 560th AMXG Starlifter Drive, Bldg. 91 Vault; 1st floor behind break room Robins AFB, GA 31098-1640 Secret Location: AFLCMC/HBG, C2ISR Division 750 Third St, Building 350 Robins AFB, GA 31098-2122

(478) 926-8226, DSN 468-8226

Secret

75 ABW/IP

72 ABW/IP

66 ABG/IP

21 SW/IP

Ref. 10.a: COMSEC/Cryptographic, Safeguarding requirements apply. See AFI 33-201 Volume 2, Communications Security (COMSEC) User Requirements and AFMAN 17-1302-O, Communications Security (COMSEC) Operations for details.

Ref. 10.j: CUI information provided under this contract shall be safeguarded as specified in DoDM 5200.0I-V4, DoD Information Security Program: Controlled Unclassified Information.

Ref. 11.e: Contract is for engineering and technical data services. Classification markings on the material to be furnished will provide the guidance necessary for performance of the contract.

Ref. 11.j: Contractor personnel will participate in the OPSEC program locally administered by the AF activity.

Ref. 12: Contractor is to submit requests through the Contracting Officer for OPSEC Program Manager review and public release authorization. The Contracting Officer will provide contractor with written approval/disapproval. (T-1) Information requiring AF or DoD–level review will be reviewed by the unit’s OPSEC Program Manager or Coordinator who will in-turn forward to 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.

TDSSe PM, AFLCMC/LZPTP rep: JAY HARVEY, NH-03, DAFC USM/OPSEC Coordinator, AFLCMC/LZP rep: MELVESE M. HARRIS, NH-03, DAFC Servicing Security Activity, 78 ABW/IP

Robins AFB, GA 31098-1813 Address: AFSC/PZIE 480 Richard Ray Blvd., Suite 202 Robins AFB, GA 31098-1813