Exhibit 3 DD Form 254 printed 06Sep24 AMD 0001.pdf
PDF 479 KB Posted
- Attached to
- Commercial Ethernet Gateway (CEG) Hawaii Federal contract opportunity
- Solicitation number
- HC101924R0004
- Issued by
- Defense Information Systems Agency
About this file
This document is a DD Form 254, which is a Department of Defense Contract Security Classification Specification. It provides guidance on the security requirements for a contract to acquire commercial Ethernet service from telecommunications service providers in Hawaii.
The key details are: The contractor will be surveying locations to develop an implementation plan and then install equipment and telecommunications infrastructure as needed. The contractor may require access to classified information and buildings with up to Secret-level storage. The contract has a Secret-level facility clearance requirement. The contract performance locations are specified, and include various military and government facilities in Hawaii. The contract also requires access to SIPRNet and WWOLS. The period of performance is a 5-year base period with two option periods. The contracting activity is the Defense Information Technology Contracting Organization-Pacific.
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CLASSIFICATION (When filled in): Unclassified
PREVIOUS EDITION IS OBSOLETE. Page 1 of 5DD 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:
June 30, 2025
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
None (See instructions)
2. THIS SPECIFICATION IS FOR: (X and complete as applicable.)
a. PRIME CONTRACT NUMBER (See instructions.)
b. SUBCONTRACT NUMBER
c. SOLICITATION OR OTHER NUMBER
HC101924R0004
DUE DATE (YYYYMMDD)
20241004
3. THIS SPECIFICATION IS: (X and complete as applicable.)
a. ORIGINAL (Complete date in all cases.)
DATE (YYYYMMDD)
20240903
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
TBD
c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)
TBD
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)
a. NAME, ADDRESS, AND ZIP CODE 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.)
a. LOCATION(S) (For actual performance, see instructions.)
See locations in block 13
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
This procurement is to acquire commercial Ethernet service from telecommunications service providers. The Contractor will be surveying the locations listed in Attachment A to develop an Implementation Plan. Upon Plan approval the contractor shall install equipment and other telecommunications infrastructure at the location as needed to implement Ethernet services. Contractor may require access to classified information pertaining to the location's design, as well as access to buildings and rooms where open storage up to the SECRET level is approved.
PREVIOUS EDITION IS OBSOLETE. Page 2 of 5DD FORM 254, APR 2018
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, WWOLS
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 DoDI 5200.48, only for specific CUI protection requirements. Non-DoD Components: see instructions.)
m. OTHER (Specify) (See 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)
DIRECT THROUGH (Specify below) Public Release Authority:
Public release of information is not authorized
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.)
Reference block 8 Government locations:
Attachment A CEG Hawaii - DISN Node and Customer Access Site List Ref# Street Address Building City State Zip
1. Hickam/Bldg. 988, 103 3rd St., Room: 110 (Frame Room); 1st Floor, Honolulu, HI 96818
2. Wahiawa/Bldg. 409, 409 Midway Drive, Room: 120; 1st Floor, Wahiawa, HI 96786, Aiea, HI 96701
3. Hawala/ Bldg. 1, Corner of Kaimakani St & Kikania St., Room: Server Room; 1st Floor
4. Red Hill Tunnel/Red Hill ADIT3 S307 Red Hill Pump Shaft, Room: Office Room; 1st Floor, Aiea, HI 96701
5. Catlin Park/Catlin Park Youth Program, 4655 Catlin Drive, Room: 117; 1st Floor, Honolulu, HI 96818
6. Helemano/Helemano Fire Station #10, 651 Kuapale Rd. Bldg. 22, Room: 104; 1st Floor, Wahiawa, HI 96786
7. Fort Derussy/Asia Pacific Center for Security Studies at Fort Derussy, Room: A206; 2nd Floor, Honolulu, HI 96815
8. Bellows/BLDG 700, 700 Bellows AFS, Room: 113; 1st Floor, Waimanalo, HI 96795
9. Manana/Bldg. 68 (Fire Station #5), 1120 Kuala St., Room: TBD; 1st Floor, Pearl City, HI 96782
PREVIOUS EDITION IS OBSOLETE. Page 3 of 5DD FORM 254, APR 2018
10. Waiawa Water Supply/Bldg. S71, (End of Waihona St.), Room: Server Room; 1st Floor, Pearl City, HI 96782
11. Waipio/Bldg. 201, 93-051 Waipio Point Access Rd., Room: Room 3 Telco Room; 1st Floor, Waipahu, HI 96797
12. Barking Sands/Bldg. 287, PMRF Barking Sands, 287 Imiloa Rd., Room: Demarc Room; 1st Floor, Kekaha, HI 96752
13. Lualualei/Bldg. 28, 28 Enterprise St., Room: CO; 1st Floor, Waianae, HI 96792
14. Pearl City Peninsula/Bldg. 992, 2293 Victor Wharf Access Road, Room: 106; 1st Floor, Pearl City, HI 96782
15. West Loch/Bldg. 600, Naval Magazine Pearl Harbor, Barracks Road, Room: 1; 2nd Floor, Ewa Beach, HI
16. Wheeler AAF/Bldg 102, 1129 Wright Ave., Room: CO; 1st Floor, Wheeler Army Airfield, HI 96854
17. Aliamanu Military Reservation, 154 Kauhini Road, Bldg 1782, Honolulu, HI, 96816
18. Aliamanu Military Reservation, 1085 Bougainvillea Loop, Bldg 1790, Honolulu, HI, 96816
19. Aliamanu Military Reservation, Bldg 186 - Bunker #186, Honolulu, HI, 96818
20. Barbers Point, TIBI - Demark 19 Shangrila Street Bldg 19 Room 106, Kapolei, HI, 96707
21. Bellows Air Force Station, Bellows AFS, Bldg 700, Waimanalo, HI, 96795
22. Catlin Park, Catlin Park Youth Program 4655 Catlin Drive - 3443 Room: 117; 1st Floor, Honolulu, HI, 96818
23. Fort Ruger, HQ HIANG, 3949 Diamond Head Road, Honolulu, HI, 96816
24. Haleakala, Bldg MSSS, Summit of Haleakala, Kula, HI, 96790
25. Pauahi Tower, 1003 Bishop Street, Pauahi Tower, Floor 22, Suite 2230, Room DCR 017, Honolulu, HI, 96813
26. Kalanimoku Bldg, 1151 Punchbowl Street, Honolulu, HI, 96813
27. Downtown Satellite City Hall, 925 Dillingham Boulevard, Honolulu, HI, 96817
28. "530 Peltier Avenue(Peltier Child Development Center)," 530 Peltier Avenue, Bldg 1925, Honolulu, HI, 96818
29. Hawaii Institute of Geophysics, 2525 Correa Road, Honolulu, HI, 96822
30. PJKK Federal Building, 300 Ala Moana Boulevard, Suite 3-243, Honolulu, HI, 96813
31. Daniel K. Inouye International Airport, 760 Worchester Avenue, Honolulu, HI, 96818
32. DRFortress Data Center, 3375 Koapaka Street, Suite I-500, Bldg 3375, Honolulu, HI, 96819
33. Fort Shafter Flats, 1557 Suehiro Road, Bldg 1543, Honolulu, HI, 96819
34. Fleet and Family Readiness Facility, 620 Main Street, Bldg 3456, Honolulu, HI, 96818
35. Kamuela, 62-3589 Queen Kaahumanu Highway (Looks to be a liquid storage tank), Kamuela, HI, 96743
36. Kihei, 590 Lipoa Parkway, Kihei, HI, 96753
37. Kunia, Bldg 9, Room 343, Kunia, HI, 96857
38. Makua Range, Makua Valley Road, Bldg 120, Waialua, HI, 96791
39. Pohakuloa Training Area, Hwy 200; Saddle Road, Bldg 106, Hilo, HI, 96720
40. Port Allen, 4300 Waialo Road, Bldg 387, Eleele, HI, 96705
41. Sand Island Coast Guard Base, 400 Sand Island Parkway Bldg 0645, Honolulu, HI, 96819
42. Waipio, 32 Waipio Point Access Road, Bldg 2, Room 2, 1st Floor, Waipahu, HI, 96797
43. Wheeler Army Air Field, 149 Haley Avenue, Hawaii Region Air Operations Center (HIRAOC), 1st Floor, Room 122, Wahiawa, 96786
44. Wheeler Army Air Field, 169th Aircraft Control & Warning Squadron (ACWS), Bldg 310, 1st Floor, Room 122, Wheeler AAF, 96854
45. Wheeler Army Air Field, 298 ADG, 149 Haley Avenue, Bldg 310, Wheeler AAF, 96854
Reference Block 10j: Contractor will be provided with and will abide by DoDM 5400.07, DoD Freedom of Information Act Program, and DoDI 5200.48 Controlled Unclassified Information (CUI), Section 3.4. Guidance provided under separate cover.
Reference Block 10k: WWOLS & SIPRNet access required at the Government facility. A NATO Secret briefing is required for SIPRNet access.
Reference Block 11a: Contractor performance is restricted to the Government activity locations listed in block 8a. The contractor or Government activity will provide security classification guidance for the performance of this contract.
Reference Block 11L: 1. DoD Components: Refer to DoDI 5200.48 Controlled Unclassified Information (CUI), Section 3.4 when considering specific requirements to be imposed on the contractor for the protection of CUI. 2. Non-DoD Components must consult with your Component-specific information security policy office to determine if you have any existing authority by law.
General Information:
All classified visit requests by contractors shall be forwarded to the Contracting Officer Representative (COR) for approval and need -to-know certification before being sent to the facility to be visited.
All visit access requests (VARs) by contractors shall be sent via the Defense Information System for Security (DISS) to the DISA VAR Center (DISS SMO: DKABAA10) or appropriate SMO for the effort. The COR/ACOR must approve the VAR prior to sending the request to the facility being visited. Contractors must also provide a copy of the VAR to the SM.
The COR/ACOR must be notified and approve the receipt and/or generation of classified information under this contract.
PREVIOUS EDITION IS OBSOLETE. Page 4 of 5DD FORM 254, APR 2018
All classified information received and/or generated under this contract is the property of the U.S. Government regardless of proprietary claims. Upon completion or termination of this contract, the U.S. Government will be contacted for destruction or disposition instructions.
Foreign Nationals will not perform on any area of the contract (classified or unclassified). Prime Contractor FSO will provide the Government a copy of the subcontractor DD Form 254 and subcontract memo for all their subcontracts meeting review criteria via a SM to submit for approval.
Period of performance: TBD Base period is from _____________ to ____________ OY1 is from _____________ to ____________ Etc…
List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form)
Soli 254 HC101924R0004 concurred 9-6-2024 NAME & TITLE OF REVIEWING OFFICIAL 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.)
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.)
16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)
a. GCA NAME
Defense Info Technology Cont Org Pacific
b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)
HC1019
c. ADDRESS (Include ZIP Code)
477 Essex Street, Bldg 77, Ste 129, Pearl Harbor, HI 96860-5815
d. POC NAME
Jodie Onaga-Nuttall
e. POC TELEPHONE (Include Area Code)
+1 (808) 786-9327
f. EMAIL ADDRESS (See Instructions) jodie.s.onaga-nuttall.civ@mail.mil
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)
Harder, Frank M.
b. TITLE
COR
c. ADDRESS (Include ZIP Code)
6916 Cooper Avenue FT. Meade, MD 20755
d. AAC OF THE CONTRACTING OFFICE (See Instructions)
HC1019
e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.)
f. TELEPHONE (Include Area Code)
+1 (301) 225-2741
g. EMAIL ADDRESS (See Instructions) frank.m.harder.civ@mail.mil
h. SIGNATURE
i. DATE SIGNED (See Instructions)
20240906
HARDER.
FRANK.M
ARON.10
22709530
Digitally signed by
HARDER.FRA
NK.MARON.10
22709530 Date: 2024.09.06 12:00:14 -04'00'
PREVIOUS EDITION IS OBSOLETE. Page 5 of 5DD FORM 254, APR 2018
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.)
File details come from the government source that posted it. Updated .