DD254.pdf

CLASSIFICATION (When filled in): Unclassified

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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:

20220531

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.)

TBD

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.)

DATE (YYYYMMDD)

20200205

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.HC1047-16-D-0011

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 c. COGNIZANT SECURITY OFFICE(S) (CSO)

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

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.)

Defense Spectrum Organization Joint Spectrum Center 2004 Turbot Landing Annapolis, MD 21402-5064 (See 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 contract will provide spectrum related support to mobile wireless service providers and other non-government entities who wish to operate on federal property in accordance with the Telecommunications act of 1996 and DoD guidance.

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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 access

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 DoDM 5200.01, Volume 4 only for specific CUI protection requirements. Non-DoD Components: see instructions.)

m. OTHER (Specify) (See instructions.)

DFARS 204.404-70, “Disclosure of Information” IT-II Requirements.

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 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.)

A. Referenced Documents: See Appendix A.

B. Acronyms: See Appendix B.

C. Program Manager:

Whitney P. McCloud, Colonel, USAF Director, Joint Spectrum Center DSN 313-919-2697 or (410) 919-2697

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 Joint Personnel Adjudication System (JPAS) to the DISA VAR Center (JPAS SMO: DKAUAA) 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.

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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.

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

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: One year base period with four one-year option periods.

Pre-award access is not required, however, the awarded contractor is required to have access to perform duties by the completion of the transition period. This DD Form 254 reflects the security requirements for the contract when awarded.

Ref Block 4: Follow-On to Contract No. HC1047-16-D0011.

Ref Block 8a: DISA Headquarters, 6916 Cooper Avenue, Fort George G. Meade, MD 20755-7901

Reference Block 10a: Contractor is authorized to receive Government furnished cryptographic equipment. Access to classified COMSEC information requires a final U.S. Government clearance at the appropriate level. Further disclosure of COMSEC information by a contractor, to include subcontracting, requires prior approval of the Government contracting activity. Non-accountable COMSEC information, though not tracked in the COMSEC material control system, may still require a level or control within a document control system. Refer to NSA/CSS Manual 3-16, Control of Communications Security Material, page E-4 for guidance. Contractor is authorized to receive Government furnished cryptographic equipment. Access to classified COMSEC information requires a final U.S. Government clearance at the appropriate level. Further disclosure of COMSEC information by a contractor, to include subcontracting, requires prior approval of the contracting activity.

Reference Block 10b: Access to RESTRICTED DATA requires a final U.S. Government clearance at the appropriate level.

Reference Block 10j: Contractor will be provided with and will abide by DoDM 5400.07, DoD Freedom of Information Act Program, and DoDM 5200.01, Volume 4, DoD Information Security Program: CUI. Guidance provided under separate cover.

Reference Block10k: SIPRNet access required. A NATO Secret briefing is required for SIPRNet.

Reference Block 11a: Contract performance is restricted to (ref 8a). The contractor or Government activity will provide security classification guidance for the performance of this contract.

Reference Block 11g:

a. Technical information on file at the Defense Technical Information Center will be made available to the contractor if the contractor requires such information.

b. The contractor must prepare and forward a DD Form 1540 to the COR/ACOR for authorization BEFORE the services may be requested.

Reference Block 11j:

The contractor will comply with OPSEC requirements contained in the contract or attached under separate cover.

Reference Block 11m: IT-II access.

List of Attachments (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form)

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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.)

TEMPEST requirements apply. Guidance provided in Block 13 as reference Block 11i. OPSEC requirements apply. Guidance provided in Block 13 as reference Block 11j.

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 Information System Agency

b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)

H98294

c. ADDRESS (Include ZIP Code)

DISA HQS COMPLEX - FT MEADE

(ACQUISITION BLDG) (ROOM A1F58D)

P.O. BOX 549 FORT MEADE, MD

20755-7090

d. POC NAME

Dustie Thompson

e. POC TELEPHONE (Include Area Code)

+1 (301) 225-4082

f. EMAIL ADDRESS (See Instructions) dustie.m.thompson.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)

Dennis R. Love

b. TITLE

Contracting Officer Representative

c. ADDRESS (Include ZIP Code)

2004 Turbot Landing Annapolis, MD 21402-5064

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

H98294

e. CAGE CODE OF THE PRIME CONTRACTOR (See Instructions.)

f. TELEPHONE (Include Area Code)

+1 (410) 919-2818

g. EMAIL ADDRESS (See Instructions) dennis.r.love.civ@mail.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

20200514

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.)

LOVE.D

ENNIS.R

AY.1296

697288

Digitally signed by

LOVE.DENNIS.

RAY.129669728

Date: 2020.05.14 15:40:45 -04'00'