Sol DD Form 254 - FA8522-23-R-0012.pdf

PDF 248 KB Posted Jun 7, 2023

Attached to: Repair of ALQ-161 Band 5 TWT
Solicitation number: FA852223R0012
Issued by: Department of the Air Force Materiel Command Air Force Sustainment Center

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SAMPLE

PREVIOUS EDITION IS OBSOLETE.

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DD FORM 254, APR 2018

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:

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

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.)

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

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" Hide Attachment Bar

CurrentPage:

PageCount:

Select classification from drop-down list.: Unclassified

Enter serial number.:

a. Facility clearance level. Select one.: 2

b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 2

Select for "original.": 0

Select for "original.": 1

Enter prime contract number.:

Select for "revised.": 0

Enter subcontract number.:

Select for "final.": 1

Select for "final.": 0

Enter solicitation or other number.: FA8522-23-R-0012

Enter due date in format YYYYMMDD.:

Enter date in format YYYYMMDD.: 20230127

Enter revision number.:

Enter date in format YYYYMMDD.:

Enter final specification.:

Enter date in format YYYYMMDD.:

Select for "no.": 0

Select for "no.": 1

Select for "yes.": 1

Select for "yes.": 0

Enter preceding contract number.: FA8522-18-D-0001

Enter contractor's request date in format YYYYMMDD.:

Enter period.:

Enter typed name of certifying official (last, first, middle initial).: STELLANT SYSTEMS INC.

3100 LOMITA BLVD

TORRANCE, CA 90505

Enter typed name of certifying official (last, first, middle initial).: N/A

Enter typed name of certifying official (last, first, middle initial).: Duval, Teresa, H

Enter CAGE code of the prime contractor.: 73293

Enter CAGE code of the prime contractor.: N/A

Enter CAGE code of the prime contractor.: 73293

Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: Defense Counterintelligence & Security Agency (DCSA)

10801 Walker Street; Suite 240 Cypress, CA 90630-5036 mailto:dcsa.dcsa-western.dcsa-isfo.mbx.cypress-field-office@mail.mil

Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: N/A

Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: Defense Counterintelligence & Security Agency (DCSA)

10801 Walker Street; Suite 240 Cypress, CA 90630-5036 mailto:dcsa.dcsa-western.dcsa-isfo.mbx.cypress-field-office@mail.mil

Select to add row to locations.:

Select to remove last row from locations.:

Select to delete all signatures.:

Enter location(s).: STELLANT SYSTEMS INC.

3100 LOMITA BLVD

TORRANCE, CA 90505

Enter general unclassified description of this procurement.: This is a follow on effort in support of the ALQ-161 to repair Traveling Wave Tubes (TWT's).

Select for "a. CONTRACTOR.": 0

Select for "a. CONTRACTOR.": 1

Select for "f. OTHER AS NECESSARY.": 1

Select for "f. OTHER AS NECESSARY.": 0

Select for "f. OTHER AS NECESSARY.": 1

Select for "b. SUBCONTRACTOR.": 0

Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0

Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0

Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 1

Select for "h. REQUIRE A COMSEC ACCOUNT.": 0

Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0

Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 1

Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0

Select for "i. HAVE A TEMPEST REQUIREMENT.": 0

Select for "e. NATIONAL INTELLIGENCE INFORMATION: - (1) Sensitive Compartmented Information (SCI).": 0

Select for "e. NATIONAL INTELLIGENCE INFORMATION: - (2) Non-SCI.": 0

Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1

Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0

Enter infomration for "other.": 78 ABW/IPD

448 SCMW/OMO Security Office

Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0

Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 1

Select for "l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI). .": 1

Select for "m.OTHER.": 0

Select for "direct.": 0

Select for ": 1

Enter specification for "through".: See Item 13

Enter public release authority.: See Item 13

Select to add signature.:

Select to remove last signature.:

text: Ref 8.a. & 11.c: Contractor performance will occur at the contractor's facility listed in block 6.a. The B-1 Weapon System

Program Security Classification Guide, dated 1 October 1997, Revision 4 - 10 October 2017, Letter Change 1 dated 30 September 2022, applies to this contract in protecting and safeguarding classified information.

Ref 10.j/11.l: The contractor shall comply with DoDI 5200.48, Controlled Unclassified Information, DoDM 5200.01V3_AFMAN 16-1404V3, Information Security Program Protection of Classified Information and DoDM 5400.7-Air Force Manual 33 302, DoD Freedom of Information Act (FOIA) Program. The contractor shall monitor CUI aggregation and compilation based on the potential to generate classified information pursuant to security classification guidance addressing the accumulation of unclassified data or information.

Ref 11.j: The contractor will be provided critical information under separate cover, if applicable.

Ref. 12: Contractor is to submit requests through the contracting officer for OPSEC program manager review and public release authorization. The contracting officer will provide contractor with written approval/disapproval. Information requiring AF or DoD-level review will be reviewed by the unit’s OPSEC program manager or coordinator who will in-turn forward to the entry-level public affairs office through the AFIMSC Public Affairs Office to the Secretary of the Air Force, Office of Public Affairs, Security and Review Division (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330-1690.

Applicable FARS and DFARS Clauses:

FAR Clause 52.204-2 Security Requirements

This clause applies to the extent that the contract involves access to information classified Confidential, Secret, or Top Secret. The clause is related to compliance with the National Industrial Security Program Operating Manual (NISPOM) and any revision to the manual for which notice has been furnished to a contractor

FAR Clause 52.204-21 Basic Safeguarding of Covered Contractor Information This clause applies to information not intended for public release that is provided by or generated for the Government under a contract to develop or deliver a product or service to the Government, but not including information provided by the Government to the public (such as on public websites) or simple transactional information, such as necessary to process payments.

DFARS Clause 252.204-7012 Safeguarding Covered Defense Information and Cyber Incident Reporting This clause requires a company to safeguard CDI, as defined in the clause, and to report to the DoD the possible exfiltration, manipulation, or other loss or compromise of unclassified CDI: or other activities that allow unauthorized access to the contractor’s unclassified information system on which unclassified CDI is resident or transiting. The company must submit the malware to DoD if the company is able to isolate it and send it safely.

The Contractor will notify the Government Contracting Activity and the Government Security Manager within 48 hours of any incident involving the actual or suspected compromise/loss of classified information to enable the Government to conduct immediate assessment of potential impact pending formal inquiry/investigation. Actual or suspected compromise of Covered Defense Information will be reported IAW DFARS Clause 252.204-7012.

DFARS Clause 252.204-7000 Disclosure of Information This cause prohibits the contractor from releasing any unclassified information pertaining to the contract or any program related to the contract, unless they have CO approval or the information is in the public domain before the date of release.

DFARS Clause 252.204.7009 Limitations on the Use or Disclosure of Third-Party Contractor Reported Cyber Incident Information. This clause is required for contractor services that include support for the Government’s activities related to safeguarding covered defense information and cyber incident reporting.

Click on this button to attach a file(s).:

rep: Andrew A. Peacock

USAF Program Manager rep: Anthony M. Migliore 448 SCMW OPSEC Manager rep: John M. Cook Unit Security Manager rep: Melvese Harris USAF Servicing Security Activity

Enter signature.:

Explain and identify specific areas and government activity responsible for inspections.:

Enter GCA name.: AFMC AFSC/PZABB

Enter AAC of the contracting office.: FA8522

Enter address (include zip code).: AFMC AFSC/PZABB

235 Byron Street, Ste 19A Robins AFB, GA 31098 Enter address (include zip code).: AFMC AFSC/PZABB 235 Byron Street, Ste 19A Robins AFB, GA 31098

Enter POC name.: Teresa Duval

Enter telephone number (include area code).: 4784975202

Enter email address.: teresa.duval@us.af.mil

Enter title.: Procurement Contracting Officer

Enter the datesigned in format YYYYMMDD.:

File details come from the government source that posted it. Updated Aug 8, 2023.