Attch 3 DD-254 Form DRAFT.pdf

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DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, MAY 2019

NEEDS DD67

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

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

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

a. ORIGINAL (Complete date in all cases.)

b. REVISED (Supersedes all previous specifications.)

4. IS THIS A FOLLOW-ON CONTRACT?

If yes, complete the following:

Classified material received or generated under

5. IS THIS A FINAL DD FORM 254?

If yes, complete the following:

6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code)

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)

8. ACTUAL PERFORMANCE (Click button to add more locations.)

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)

e. NATIONAL INTELLIGENCE INFORMATION:

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.)

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)

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.)

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, 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 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.

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)

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.

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

9.0.0.2.20120627.2.874785 DD 254, DoD Contract Security Classification Specification whs.mc-alex.esd.mbx.formswebmaster@mail.mil

WHS

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

1100 International Plaza, Suite 100 Chesapeake, VA 23323

227 Bendix Rd. Suite 200 Virginia Beach, VA23451 (757)457-3270

CSO: FORCES SURVEILLANCE SUPPORT CENTER

1298 OLYMPIC BLVD, BLDG 310

CHESAPEAKE, VA 23322

CSO: FORCES SURVEILLANCE SUPPORT CENTER

1298 OLYMPIC BLVD, BLDG 310

CHESAPEAKE, VA 23322

CSO: FORCES SURVEILLANCE SUPPORT CENTER

1298 OLYMPIC BLVD, BLDG 310

CHESAPEAKE, VA 23322

CSO: FORCES SURVEILLANCE SUPPORT CENTER

1298 OLYMPIC BLVD, BLDG 310

CHESAPEAKE, VA 23322

CSO: FORCES SURVEILLANCE SUPPORT CENTER

1298 OLYMPIC BLVD, BLDG 310

CHESAPEAKE, VA 23322

CSO: FORCES SURVEILLANCE SUPPORT CENTER

1298 OLYMPIC BLVD, BLDG 310

CHESAPEAKE, VA 23322

CSO: FORCES SURVEILLANCE SUPPORT CENTER

1298 OLYMPIC BLVD, BLDG 310

CHESAPEAKE, VA 23322

RELAY ROAD, BLDG 344

CHESAPEAKE, VA 23322

Location: FORCES SURVEILLANCE SUPPORT CENTER

1298 OLYMPIC BLVD, BLDG 310

CHESAPEAKE, VA 23322

Location: 998 ROCKAHOCK BAR RD

NEW KENT, VA, 23124

Location: ESCONFIFO RANCH MCMULLEN COUNTY

FREER, TX, 78357

Location: KINGS RANCH NORTH ELLA PASTURE

ROUTE 281 JIM WELLS COUNTY PREMONT, TX 78375

Location: PUERTO RICAN NATIONAL GUARD BASE, FORT ALLEN

JUANA DIAZ, PUERTO RICO 00795

2. The Contractor shall implement procedures whereby any loss, compromise, suspected loss or compromise of classified information or material, and loss of unclassified information issued under this contract shall be promptly reported to the Cognizant Security Office, FSSC Security Manager and Contract Facility Security Office (FSO).

3. Information on this contract is not releasable to personnel possessing reciprocal clearance without the written approval of the Director, FSSC via FSSC Security Manager.

4. All Visit Authroization Letters (VAL) or Visit Request (VR in the performance of this contract shall be forwarded via DISS or FSSA SMO Code 458545 for certification of "Need-to-Know". All request shall not exceed the completion date of the contract or a 12 month period, which ever is shorter.

5. Only persons actually performing classified tasks on this contract shall be required to possess a security clearance at the Secret Level. Some personnel performing duties on Classified Networks may be required investigations at the Top Secret Level, performing SECRET duties. Personnel must meet all security requirements prior to being processed for a FSSC access badge. If the perspective contractor personnel do not meet the necessary security requirements, the Contractor's Facility Security Officer (FSO) will be notified for the appropriate security action to be taken.

6. Classified material shall only be distributed by the Director, FSSC or his designated representative as required in the performance of this contract. All classified information marked as required by Executive Order (EO) 13526, "Classified National Security Information".

7. Documentation obtained for use with this contract shall not be used for any other purpose unless prior authorization has been obtained from the Director, FSSC in accordance with the NISPOM.

8. Upon termination of a Contractor employee with a FSSC access badge or active VAL on file, the Contractor’s FSO must notify the FSSC Security Manager of the termination and effective date. Immediately confiscate FSSC issued access badge and Common Access Card (CAC), if issued and return them to the FSSC Security Manager no later than five working days after the effective date of the termination.

9. Upon termination of this contract, all documentation shall be returned to FSSC along with the appropriate accountability and control records.

10. Any revisions to this contract must be forwarded to the FSSC COR for the contract.

11. Intelligence Information (Non-SCI): Contractor shall comply with DCID 1/7, “Security Controls on the Dissemination of Intelligence Information”. Further disclosure, to include subcontracting, of intelligence information by a Contractor requires prior approval from the Director, FSSC.

11a. Contractors performance is restricted to facilities or as specifically authorized by the Director, FSSC.

11c/d. Contractor shall comply with the security guidance as stated in Block 13.

11h/k. Required in conjunction with Block 10a.

11l. Contractor shall comply with security guidance stated for Block 10j/k

2. Implementation of FSSC Operations Security Program is required [Block 11j pertains].

PHILADELPHIA, PA 19111-5083

Address: 1298 OLYMPIC BLVD, BLDG 310

CHESAPEAKE, VA 23322-4098