Attachment_2__DD_254.pdf

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WSD Warehouse Support Services Federal contract opportunity
Solicitation number
HC1028-17-R-0021
Issued by
Defense Information Systems Agency

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DD254

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HC1028-17-R-0021_AMD0003.docx DOCX document
updated_question_49.pdf PDF
Site_visit_attendees_17R0021.pdf PDF
17R0021_QA_2_final.pdf PDF
HC1028-17-R-0020_AMD0002.docx DOCX document
Attachment_6__ID_Docs.pdf PDF
17R0021_0001.docx DOCX document
17R0021_QA_1_final.pdf PDF
Attachment_5__PP_Ref.doc DOC document
HC1028-17-R-0021.docx DOCX document
Attachment_4__GFE_listing.pdf PDF
Attachment_1_QASP.docx DOCX document
Attachment_3__CLIN_Worksheet.xlsx XLSX spreadsheet
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DEPARTMENT OF DEFENSE

CONTRACT SECURITY CLASSIFICATION SPECIFICATION

(The requirements of the DoD Industrial Security Manual apply to all security aspects of this effort.)

1. CLEARANCE AND SAFEGUARDING

a. FACILITY CLEARANCE REQUIRED

b. LEVEL OF SAFEGUARDING REQUIRED

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

a. PRIME CONTRACT NUMBER

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER DUE DATE (YYYYMMDD)

3. THIS SPECIFICATION IS: (X and complete as applicable)

a. ORIGINAL (Complete date in all cases)

REVISION NO.

c. FINAL (Complete Item 5 in all cases)

DATE (YYYYMMDD)

b. REVISED (Supersedes all previous specs)

DATE (YYYYMMDD)

DATE (YYYYMMDD)

4. IS THIS A FOLLOW-ON CONTRACT? YES NO. 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? YES NO. 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 b. CAGE CODE c. COGNIZANT SECURITY OFFICE (Name, Address, and Zip Code)

7. SUBCONTRACTOR

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

8. ACTUAL PERFORMANCE

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

9. GENERAL IDENTIFICATION OF THIS PROCUREMENT

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

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION

b. RESTRICTED DATA

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION

d. FORMERLY RESTRICTED DATA

e. INTELLIGENCE INFORMATION

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

f. SPECIAL ACCESS INFORMATION

g. NATO INFORMATION

h. FOREIGN GOVERNMENT INFORMATION

i. LIMITED DISSEMINATION INFORMATION

j. FOR OFFICIAL USE ONLY INFORMATION

k. OTHER (Specify)

a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT ANOTHER

CONTRACTOR'S FACILITY OR A GOVERNMENT ACTIVITY

b. RECEIVE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE AND GENERATE CLASSIFIED 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 TEMPEST REQUIREMENTS

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

k. BE AUTHORIZED TO USE THE DEFENSE COURIER SERVICE

l. OTHER (Specify)

DD FORM 254, DEC 1999 PREVIOUS EDITION IS OBSOLETE.

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

a. TYPED NAME OF CERTIFYING OFFICIAL

Direct Through (Specify)

d. ADDRESS (Include Zip Code)

Yes No to the Directorate for Freedom of Information and Security Review, Office of the Assistant Secretary of Defense (Public Affairs)* for review.

*In the case of non-DoD User Agencies, requests for disclosure shall be submitted to that agency.

13. SECURITY GUIDANCE. The security classifiection guidance needed for this classified 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. Add additional pages as needed to provide complete guidance.)

14. ADDITIONAL SECURITY REQUIREMENTS. Requirements, in addition to ISM requirements, 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 cognizant security office. Use Item 13 if additional space is needed.)

Yes No15. INSPECTIONS. Elements of this contract are outside the inspection responsibility of the cognizant security office.

(If Yes, explain and identify specific areas or elements carved out and the activity responsible for inspections. Use Item 13 if additional space is needed.)

16. CERTIFICATION AND SIGNATURE. 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.

b. TITLE c. TELEPHONE (Include Area Code)

e. SIGNATURE

17. REQUIRED DISTRIBUTION

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. OTHERS AS NECESSARY

DD FORM 254 (BACK), DEC 1999

DD FORM 254, SECURITY SIGNATURE PAGE

PRIME CONTRACT NUMBER:

SUBCONTRACT NUMBER: _

CERTIFICATION AND SIGNATURES: “Security requirement stated herein are completed and adequate for safeguarding the classified information to be release or generated under this classified effort. All questions shall be referred to the official named below.”

Security Office Approval

Name:

Title:

Security Office Approval

Fillable DD254 with Cont Security Page and Electronic Signature.pdf
DD254 Fillable with Security Page and Electronic Signature
ddform 254 cont
ddform254cont2
ddform 254 cont.pdf
ddform254cont1
ddform254cont2
ddform 254 cont.pdf
ddform254cont1
ddform254cont2
a_FACILITY_CLEARANCE_REQU: SECRET
b_LEVEL_OF_SAFEGUARDING_R: NONE
FillText1: Off
FillText3: Off
FillText5: Yes
DUE_DATE_YYYYMMDD:
3_A: Original.
DATE_YYYYMMDD: 20170119
3_B: Off
REVISION_NO:
DATE_YYYYMMDD1:
3_C: Off
DATE_YYYYMMDD2:
4_Yes: Off
4_No: No
YES1:
5_Yes: Off
5_No: No
FillText12:
FillText11:
a_NAME_ADDRESS_AND_ZIP_CO:
b_CAGE_CODE:
c_COGNIZANT_SECURITY_OFFI:
a_NAME_ADDRESS_AND_ZIP_C1:
b_CAGE_CODE1:
c_COGNIZANT_SECURITY_OFF1:
a_LOCATION: Defense Information System Agency

6906 Cooper Avenue Fort George G. Meade, Maryland 20755

b_CAGE_CODE2:
c_COGNIZANT_SECURITY_OFF2:
9_GENERAL_IDENTIFICATION: Provide Warehousing and Property Accountability Services.
12_Public_Release_Direct: Off
12_Public_Release_Through: Through.
release: HQ DISA Public Affairs Office
13_Rules:
13_2:
security: General Information:

All classified visit request 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 Joint Personnel Adjudication System (JPAS) to the DISA VAR Center (JPAS SMO:DKABAA10) or appropriate SMO for the effort. The COR/TM 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 security manager.

The COR/TM must be notified and approve the receipt and/or generation of classified information under this contract.

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).

Reference Block 10j: Contractor will be provided with and will abide by DoD Regulation 5400.7, DoD Freedom of Information Act Program, and DoD 5200.01-M, Information Security Program. Guidance provided under separate cover.

Reference Block 11a: Contract performance is restricted to DISA & Supporting NCR 6906 Cooper Avenue Fort Meade, MD 20755. The using contractor or Government activity will provide security classification guidance for the performance of this contract.

14_Yes: Yes
14_No: Off
addit_sec: Reference Block 10e(2): The contractor will abide by DCID 6/6 (formerly 1/7), Security Controls on the Dissemination of Intelligence Information, 11 July 2001. Provided under separate cover.
15_Yes: Off
15_No: No
Inspections:
a_TYPED_NAME_OF_CERTIFYIN: Angela E. Sherrod
b_TITLE: COR
c_TELEPHONE_Include_Area: 3012251883
d_ADDRESS_Include_Zip_Cod: Defense Information System Agency

6906 Cooper Avenue Fort George G. Meade, Maryland 20755

e_SIGNATURE:
FillText21: Yes
FillText22: Yes
FillText23: Yes
FillText24: Off
FillText25: Yes
FillText26: Yes
f_OTHERS_AS_NECESSARY:
Reset:
FillText15:
FillText16:
13_cont2:
13_cont1: Equipment Maintenance Services – Reference Block 11e: Contract is for equipment maintenance services on equipment which processes classified information. Actual knowledge of, generation, or production of classified information is not required for performance of the contract. Cleared personnel are required to perform the service because access to classified information cannot

be precluded by escorting personnel. Any classified guidance needed will be provided by the using activity.

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).

a_PRIME_CONTRACT_NUMBER:
b_SUBCONTRACT_NUMBER:
Signature3Name:
Signature5Name:
Signature6Name:
Signature7Name:
c_SOLICITATION_OR_OTHER_N: HC1028-17-R-0021
13_cont3:
13_cont4:
13_cont5:
10a_COMMUNICATIONS_SECURIT1: Off
10c_CRITICAL_NUCLEAR_WEAPO1: Off
10d_FORMERLY_RESTRICTED_DA1: Off
10e1_Sensitive_Compartmente1: Off
10e2_NonSCI1: Yes
10f_SPECIAL_ACCESS_INFORMA1: Off
10g_NATO_INFORMATION1: Off
10h_FOREIGN_GOVERNMENT_INF1: Off
10i_LIMITED_DISSEMINATION_1: Off
10j_FOR_OFFICIAL_USE_ONLY_I: Yes
10a_COMMUNICATIONS_SECURIT2: Yes
10b_RESTRICTED_DATA2: Yes
10c_CRITICAL_NUCLEAR_WEAPO2: Yes
10d_FORMERLY_RESTRICTED_DA2: Yes
10e1_Sensitive_Compartmente2: Yes
10f_SPECIAL_ACCESS_INFORMA2: Yes
10g_NATO_INFORMATION2: Yes
10h_FOREIGN_GOVERNMENT_INF2: Yes
10i_LIMITED_DISSEMINATION_2: Yes
10j_FOR_OFFICIAL_USE_ONLY_1: Off
10k_OTHER_Specify1: Yes
10k_OTHER_Specify: Off
10kother1:
11a_COMMUNICATIONS_SECURIT3: Yes
11a_COMMUNICATIONS_SECURIT4: Off
11b_RESTRICTED_DATA3: Off
11b_RESTRICTED_DATA4: Yes
11c_CRITICAL_NUCLEAR_WEAPO3: Off
11c_CRITICAL_NUCLEAR_WEAPO4: Yes
11d_FORMERLY_RESTRICTED_DA3: Off
11d_FORMERLY_RESTRICTED_DA4: Yes
11e_INTELLIGENCE_INFORMATI3: Yes
11e_INTELLIGENCE_INFORMATI4: Off
11f_Sensitive_Compartmente4: Yes
11e_Sensitive_Compartmente3: Off
11g_NonSCI3: Off
11g_NonSCI4: Yes
11h_SPECIAL_ACCESS_INFORMA3: Off
11h_SPECIAL_ACCESS_INFORMA4: Yes
11i_NATO_INFORMATION3: Off
11i_NATO_INFORMATION4: Yes
11j_FOREIGN_GOVERNMENT_INF3: Off
11j_FOREIGN_GOVERNMENT_INF4: Yes
11k_LIMITED_DISSEMINATION_3: Off
11k_LIMITED_DISSEMINATION_4: Yes
11_OTHER_Specify: IT-II access for NIPR only
11i_Other1: Yes
11i_Other2: Off
10e2_NonSCI2: Off
10b_RESTRICTED_DATA1: Off
13c_SOLICITATION_OR_OTHER_N_1: HC1028-17-R-0021
pageC_3:
pageC_4:
pageC_5:
pageC_2: 3
pageC_1: 2
SignatureTitle3Name:
SignatureTitle5Name:
SignatureTitle6Name:
SignatureTitle7Name:
Button2:

File details come from the government source that posted it. Updated .