Draft_DD254.pdf
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- HSCGG3-18-R-PWX700
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Draft DD254
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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. Adobe Professional 7.0
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 classification 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
| fac_clear: Secret |
| safe_level: None |
| prime_no: |
| xprime: Off |
| sub_no: |
| xsub: Off |
| xsolic: Yes |
| solic_no: HSCGG3-18-R-PWX700 |
| due_date: 20170705 |
| xspec3: Orig |
| orig_date: |
| rev_no: |
| rev_date: |
| final_date: |
| xfollowon: No |
| prec_no: |
| xfinal: No |
| req_dated: |
| period: |
| ctr_name: |
| ctr_cage: |
| ctr_ofc: |
| sub_name: |
| sub_cage: |
| sub_ofc: |
| perf_loc: C4IT Service Center |
Operations Service Center (OSC) U.S. Coast Guard (USCG) 408 Coast Guard Drive Kearneysville, WV 25430
| perf_cage: N/A |
| perf_ofc: Command Security Officer |
Operations Service Center (OSC) U.S. Coast Guard (USCG) 408 Coast Guard Drive Kearneysville, WV 25430
| gen_id: This DD-254 is draft and is for planning purposes only. |
| x10a: No |
| x10b: No |
| x10c: No |
| x10d: No |
| x10e1: No |
| x10e2: No |
| x10f: No |
| x10g: No |
| x10h: No |
| x10i: No |
| x10j: Yes |
| x10k: Yes |
| other10k: SIPRNET |
| x11a: Yes |
| x11b: Yes |
| x11c: Yes |
| x11d: Yes |
| x11e: Yes |
| x11f: Yes |
| x11g: Yes |
| x11h: Yes |
| x11i: Yes |
| x11j: Yes |
| x11k: Yes |
| x11l: Yes |
| other11l: |
| xrelease: No |
| release_thru: USCG C4ITSC OSC |
408 Coast Guard Drive Kearneysville, WV 25430 guidance: REFERENCES
a. National Industrial Security Program Operating Manual - DOD 5200.22-M
b. Coast Guard Industrial Security Program - COMDTINST 5520.13A
b. Classification Information Management Program Manual - COMDTINST M5510.23
c. Operations Security Program - COMDINST M5510.24
d. Personnel Security and Suitability Program - COMDINST 5520.12C
e. DHS Management Directive (MD) 11042.1 for the handling of Sensitive but Unclassified/FOUO Information
f. DHS Management Directive 11056.1 for the handling of Sensitive Security Information (SSI)
g. Operations Security (OPSEC) Program, COMDTINST M5510.24 (Series)
h. DHS Administrative Security Program, DHS Instruction 121-01-011 The NISPOM, DoD 5220.22-M is established as a “baseline” standard for safeguarding classified material. The primary United States Coast Guard (USCG) and Department of Homeland Security (DHS) directives listed above are intended to aid the contractor in safeguarding USCG information, technologies and assets, when applicable. The contractor is responsible for complying with any future changes to the NISPOM and other applicable directives. FAR 52.204-2, Security Requirements Clause, shall be incorporated into this contract.
Ref 10K. Secret Internet Protocol Network (SIPRNET) access is required. The contractor shall not access, download or further disseminate any special access data (i.e. intelligence, NATO, COMSEC, etc.) outside the execution of the defined contract requirements and without the guidance and written permission of the KO. SIPRNet contains NATO information and a NATO awareness brief is required for everyone who needs access to SIPRNET. In the event that any special access is required, the KO must modify the requirements for the DD Form 254.
| xaddlsec: Yes |
| addl_sec: PWS stipulates support of the Coast Guard Resources and Capabilities Evaluation (CG-RACE) System. Per the PWS: CG-Race resides on the Secret Internet Protocol Router Network (SIPRNet) Department of Defense network for the exchange of classified information and messages at the SECRET level. |
| xinsp: Yes |
| inspections: All aspects of this contract and the infrastructure (facility and network) are fall under Department of Defense (DOD), Department of Homeland Security (DHS), and US Coast Guard security oversight. |
DSS is responsible for classified security oversight at the Contractor's location.
USCG retains oversight for classified collateral oversight at USCG facilities.
| cert_name: Kathy P. Klein |
| cert_title: Contracting Officer |
| cert_phone: 304-264-2566 |
| cert_addr: USCG OSC Martinsburg |
408 Coast Guard Drive Kearneysville, WV 25430
| cert_sign: |
| x17a: Yes |
| x17b: Yes |
| x17c: Yes |
| x17d: Off |
| x17e: Yes |
| x17f: Off |
| other_dist: |
| Reset: |
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