Attachment_3_-_DD254_and_Coverpage.pdf

5 JULY 18

Air Force Materiel Command Air Force Life Cycle Management Center

Battle Management Directorate Strategic Warning and Surveillance Systems Division

(AFLCMC/HBQ)

SSM-R, ATCH 3

SOLID STATE MODULE REPLACEMENT (SSM-R)

DD 254 (CONTRACT SECURITY CLASSIFICATION SPECIFICATION)

SOLICITATION NO.: FA8723-18-R-0005

ATTACHMENT 3

FA8723-18-R-0005

CLASSIFICATION (When filled in): Unclassified

DEPARTMENT OF DEFENSE 0MB No. 0704-0567

CONTRACT SECURITY CLASSIFICATION SPECIFICATION 0MB approval expires:

(The requirements of the National Industrial Security Program (NISP) apply to all security aspects ofthis effort involving classified information.) October 31, 2020

The public reporting burden tor this conectlon of information; 0704�0567, is estimated to avef"El:go 70 minutes per response, Including the- time fof 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.mbKdd-dod-intonnation-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subjectto any penalty for failing to comply with a collection of information if it does not display a currently valid 0MB control number.

RETURN COMPLETED FORM AS DIRECTED IN THE INSTRUCTIONS.

1. CLEARANCE AND SAFEGUARDING

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/ (See Instructions} MATERIAL REQUIRED AT CONTRACTOR FACILITY

Secret None {See instructions)

2. THIS SPECIFICATION IS FOR: (X and complete as applicable) 3. THIS SPECIFICATION IS: (X an.d complete as applicable)

a. PRIME CONTRACT NUMBER (See instructions)

0 ORIGINAL (Complete date in all cases)

DATE (YYYYMMDD)

a.

20180615

b. SUBCONTRACT NUMBER b. REVISED (Supersedes all previous specifications.)

D REVISION NO. DATE (YYYYMMDD)

c. SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMDD)

D F A8723-l 8-R-0005

c. FINAL (Complete Item 5 in all cases) DATE (YYYYMMDD}

4. IS THIS A FOLLOW-ON CONTRACT? l2sJ No 0Yes 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? i:gj No D 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 GovemmentEntity (CAGE) Code)

a. NAME, ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO)

TBD

(Name, Address, ZIP Code, Telephone required; Email Address optional)

TBD

TBD

7. SUBCONTRACTOR(S) (Click button if you choose lo add or list the subcontractors

- but will still require a separate DD Form 254 issued by a prime contractor to each subcontractor}

a. NAME, ADDRESS, AND ZIP CODE b.CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO)

NIA

(Name, Address, ZIP Code, Telephone required; Email Address optional)

NIA

NIA

8. ACTUAL PERFORMANCE (Click button to add more locations)

a. LOCATION(S) (For actual performance, see. instructions) b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO)

Contractor Site location. (If applicable, (Name, Address, ZIP Code, Telephone required; Email Address optional) see Instructions)

a. LOCATION(S) (For actual performance, see instructions) b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO)

7SWS (If applicable, (Name, Address, ZIP Code, Telephone required; Email Address optional).

BUILDING 5761, 7400 SPENCERPAUL ROAD

see Instructions) 9 RW/IP

17852 16th STREET, BUILDING 25216 RM 125

BEALE AFB, CA 95903-1019

BEALE AFB, CA 95903

DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE. Page 1 of 5 AEM LiveCycle Designer

CLASSIFICATION (Whenfiffed in): Unclassified