J-Attachment 7 - DD Form 254.pdf

CLASSIFICATION (When filled in):

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DD FORM 254, APR 2018 PREVIOUS EDITION IS OBSOLETE. Page 1 of 3 AEM LiveCycle Designer

DD 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)

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

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

a. PRIME CONTRACT NUMBER (See instructions.)

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)

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 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.) 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

Unclassified

Unclassified

Industrial Security Management System

Secret None

c. SOLICITATION NUMBER

19AQMM-23-R-0142

✔ 20230623

X

X

Department of State locations

19AQMM

Indefinite Delivery/Indefinite Quantity GLOBALCAP contract to provide professional services at Department of State locations worldwide

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DD 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

b. RESTRICTED DATA

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.)

d. FORMERLY RESTRICTED DATA

e. NATIONAL INTELLIGENCE INFORMATION:

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

g. NORTH ATLANTIC TREATY ORGANIZATION

(NATO) INFORMATION

h. FOREIGN GOVERNMENT INFORMATION

i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI) (See instuctions.)

k. OTHER (Specify) (See instructions.)

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.)

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:

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.)

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

Unclassified

Unclassified

Industrial Security Management System k.1. SENSITIVE BUT UNCLASSIFIED INFORMATION (SBU) m.1. REQUIRE CONNECTIVITY TO DEPT. STATE COMPUTER SYSTEM

Overseas access to classified information at Department of State locations only

Department of State, DS/IS/IND, SA-20, 13th Floor, Washington, DC 20520

[ DD Form 254 Section 13 Security Guidance is provided separately starting on page 4. ]

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DD FORM 254, APR 2018

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

b. ACTIVITY ADDRESS CODE (AAC) OF THE

CONTRACTING OFFICE (See Instructions)

c. ADDRESS (Include ZIP Code) d. POC NAME

e. POC TELEPHONE (Include Area Code)

f. EMAIL ADDRESS (See Instructions)

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)

b. TITLE

c. ADDRESS (Include ZIP Code)

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

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

f. TELEPHONE (Include Area Code)

g. EMAIL ADDRESS (See Instructions)

h. SIGNATURE

i. DATE SIGNED (See Instructions)

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.)

Unclassified

Unclassified

Industrial Security Management System

Nisha Faumuina, WCSS Principal Team Lead

X

X

Department of State

19AQMM

2201 "C" Street, NW Washington, DC 20520

Janice Custard-Lazarchick

(571) 345-3023

Custard-lazarchickJN@state.gov for Kim Colon

Division Chief

DS/IS/IND, SA-20, 13th Fl.

2201 C St. NW Washington, DC 20520

19AQMM

(571) 345-3032

ColonK@state.gov

13. SECURITY GUIDANCE.

DD FORM 254, SECURITY GUIDANCE Page 4 of 5 Industrial Security Management System

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.

Contractor personnel assigned to this contract shall possess a SECRET personnel security clearance, commensurate with their level of access, issued by the Defense Counterintelligence and Security Agency (DCSA), prior to contract performance. Uncleared individuals specifically authorized by the Contracting Officer's Representative (COR) to perform on-site in DOS facilities, only on unclassified portions of the contract and/or in areas not requiring cleared access must still be processed for DOS personal identification cards (badges) in accordance with the DOS Personal Identification Card Issuance Procedures.

A Final SECRET clearance and favorable Diplomatic Security (DS) name check is required for travel to specific HUMINT threat posts for deployments of less than 60 days (cumulative for all posts visited in a calendar year). An Interim SECRET clearance is not acceptable for travel. Deployments in excess of 60 days are NOT AUTHORIZED.

Visit Authorization Requests (VAR) are to be sent to Department of State (DOS), DS/IS/IND, Washington, DC 20520, via email: DS_IND_contractorVARS@state.gov. A VAR is valid for 12 months; an updated VAR is required 30 days prior to the current VAR expiring.

All DD Forms 254 for proposed subcontractors required to provide cleared personnel shall be forwarded to DS/ IS/IND for generation and certification prior to issuance to the subcontractor and prior to access to any classified information or controlled access areas. Proposed subcontractors must be reviewed by DS/IS/IND prior to contract performance. The prime contractor shall provide a current signed (by both parties) Subcontract Agreement (with subcontract number listed) between the entities outlining specific Statement of Work (SOW) to be performed by the subcontractor, to include all security requirements.

While at DOS locations, the contractor shall comply with applicable DOS regulations relative to protection of classified and/or sensitive information, including the National Industrial Security Program Operating Manual (NISPOM) (32 CFR Part 117) and 12 Foreign Affairs Manual (FAM) 500 and 600. DS/IS/IND is responsible for reviewing contractors assigned to DOS locations.

Security clearance requirements for contractors accessing DOS domestic or overseas information systems shall be in accordance with 12 FAM 600. Furthermore, citizens of specifically designated human intelligence and/or technical intelligence threat countries shall not develop, modify, or perform maintenance on software developed for use on DOS computer systems without approval by DS/CTS.

Contractors shall immediately report any adverse information concerning any cleared contractor employees performing on DOS contracts to DCSA in accordance with the NISPOM and to DS/IS/IND in accordance with 12

FAM 576.

Contractor personnel working on DOS contracts must report impending marriage, cohabitation and other continuing bonds of affection with foreign nationals to the COR and DS/IS/IND, in accordance with 12 FAM 275.

Classified information cannot be generated or processed on Information Systems (IS), including standalone computers, without DCSA approval, in accordance with Chapter 8 of the NISPOM. If the contractor receives DCSA approval for classified IS processing, a copy of the written approval must be forwarded to DS/IS/IND prior to the processing of any DOS classified information.

Classified storage is not required for performance on this contract; therefore, no discussion, storage, or generation of classified information shall take place at the contractor's facility.

SBU Information: See 12 FAM 540 for guidance regarding Handling, Access, Dissemination, and Release of SBU

All FAM references can be viewed at http://foia.state.gov/.

13. SECURITY GUIDANCE.

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DS/IS/IND Point of Contact: Andrew Seropian / 771-206-2640 / SeropianAR@state.gov

DS/IS/IND Alternate Point of Contact: DSIND_PSD@state.gov