Attachment_0005_-_WSTARS_DD254_REV_2.pdf
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- W52P1J17R0008
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Attachment 005 - WSTARS DD254_REV 2
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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.
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 classifiection 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
| a_FACILITY_CLEARANCE_REQU: SECRET |
| b_LEVEL_OF_SAFEGUARDING_R: SECRET |
| FillText1: Off |
| a_PRIME_CONTRACT_NUMBER: TBD |
| DATE_YYYYMMDD: 20160824 |
| FillText3: Off |
| b_SUBCONTRACT_NUMBER: |
| REVISION_NO: |
| DATE_YYYYMMDD1: |
| FillText5: Off |
| c_SOLICITATION_OR_OTHER_N: |
| DUE_DATE_YYYYMMDD: |
| DATE_YYYYMMDD2: |
| YES1: |
| FillText12: |
| FillText11: |
| a_NAME_ADDRESS_AND_ZIP_CO: TBD |
| b_CAGE_CODE: |
| c_COGNIZANT_SECURITY_OFFI: TBD |
| a_NAME_ADDRESS_AND_ZIP_C1: TBD |
| b_CAGE_CODE1: |
| c_COGNIZANT_SECURITY_OFF1: TBD |
| a_LOCATION: TBD |
| b_CAGE_CODE2: |
| c_COGNIZANT_SECURITY_OFF2: TBD |
| 9_GENERAL_IDENTIFICATION: |
| a_COMMUNICATIONS_SECURIT1: Yes |
| a_COMMUNICATIONS_SECURIT2: Off |
| b_RESTRICTED_DATA1: Off |
| b_RESTRICTED_DATA2: Yes |
| c_CRITICAL_NUCLEAR_WEAPO1: Off |
| c_CRITICAL_NUCLEAR_WEAPO2: Yes |
| d_FORMERLY_RESTRICTED_DA1: Off |
| d_FORMERLY_RESTRICTED_DA2: Yes |
| 1_Sensitive_Compartmente1: Yes |
| 1_Sensitive_Compartmente2: Off |
| 2_NonSCI1: Yes |
| 2_NonSCI2: Off |
| f_SPECIAL_ACCESS_INFORMA1: Off |
| f_SPECIAL_ACCESS_INFORMA2: Yes |
| g_NATO_INFORMATION1: Yes |
| g_NATO_INFORMATION2: Off |
| h_FOREIGN_GOVERNMENT_INF1: Yes |
| h_FOREIGN_GOVERNMENT_INF2: Off |
| i_LIMITED_DISSEMINATION_1: Off |
| i_LIMITED_DISSEMINATION_2: Yes |
| j_FOR_OFFICIAL_USE_ONLY_I: Yes |
| j_FOR_OFFICIAL_USE_ONLY_1: Off |
| k_OTHER_Specify: Off |
| k_OTHER_Specify1: Yes |
| a_COMMUNICATIONS_SECURIT3: Yes |
| a_COMMUNICATIONS_SECURIT4: Off |
| b_RESTRICTED_DATA3: Off |
| b_RESTRICTED_DATA4: Yes |
| c_CRITICAL_NUCLEAR_WEAPO3: Yes |
| c_CRITICAL_NUCLEAR_WEAPO4: Off |
| d_FORMERLY_RESTRICTED_DA3: Yes |
| d_FORMERLY_RESTRICTED_DA4: Off |
| e_INTELLIGENCE_INFORMATI3: Off |
| e_INTELLIGENCE_INFORMATI4: Yes |
| 1_Sensitive_Compartmente3: Yes |
| 1_Sensitive_Compartmente4: Off |
| 2_NonSCI3: Yes |
| 2_NonSCI4: Off |
| f_SPECIAL_ACCESS_INFORMA3: Yes |
| f_SPECIAL_ACCESS_INFORMA4: Off |
| g_NATO_INFORMATION3: Off |
| g_NATO_INFORMATION4: Yes |
| h_FOREIGN_GOVERNMENT_INF3: Yes |
| h_FOREIGN_GOVERNMENT_INF4: Off |
| i_LIMITED_DISSEMINATION_3: Yes |
| i_LIMITED_DISSEMINATION_4: Off |
| 1_OTHER_Specify: |
| FillText13: Off |
| FillText14: Yes |
| a_TYPED_NAME_OF_CERTIFYIN: Nathaniel Broadhurst |
| b_TITLE: PM DCATS Information Management Officer |
| c_TELEPHONE_Include_Area: 703-806-0013 |
| d_ADDRESS_Include_Zip_Cod: PM DCATS |
Attn: SFAE-PS-TS, 9351 Hall Road, Fort Belvoir, CA 22060
| e_SIGNATURE: |
| FillText21: Yes |
| FillText22: Yes |
| FillText23: Yes |
| FillText24: Yes |
| FillText25: Yes |
| FillText26: Yes |
| f_OTHERS_AS_NECESSARY: |
| FillText15: |
| FillText16: |
| other1: |
| release: PM DCATS |
SFAE-PS-TS, Attn. Beth Smith 9351 Hall Rd. Fort Belvoir, VA 22060 Contractor is not authorized to further disclose or release SCI (including release to a subcontractor) without prior written authorization.
security: 10a. Contractor personnel requiring COMSEC access must be U.S. citizens and possess a final clearance at the appropriate level. All contractors shall be briefed before access to COMSEC is granted. Subcontractors requiring classified COMSEC information shall be awarded only upon the written approval of the Contracting Officer.
10e(1). Sensitive Compartmentalized Information access Required. Guidance will be provided by the user agency.
10e(2). Non SCI Intelligence Materials Access Required. Guidance will be provided by the user agency.
10g. Contractor will require access to NATO information should adhere to the guidelines as stipulated within paragraph 2.2(b) of the PWS.
10h. Access to NATO information requires a final government clearance at the appropriate level as well as a security briefing.
10j. Safeguarding 'For Official Use Only' (FOUO) Information. Reference: AR 25-55. Chapter IV Appendix D.
10k. Security Classification Guide (SCG) Wideband Global SATCOM (WGS), 21 December 2011 (SCG will be forwarded under separate cover).
11a. Access to the classified information will only be at other CONUS/OCONUS locations stipulated by the Government Task Leader and or Contracting Officer's Representative.
11c. Contractor is required to generate/receive classified information in order to complete IA tasks and troubleshoot issues identified in the JSEC Lab and field.
11d. Contractor is required to store classified materials in support of 11c.
11f. Contractor will require access to classified information at OCONUS US facilities located in Table 1-1, paragraph 1.6.5 of the PWS and any additional locations may be directed by the US Government.
11g. Contractor will prepare and process DD Form 1540 and DD Form 2345 through the office listed in Block 12 for authorized access to DTIC.
11h. Contractor will be required to obtain a COMSEC account.
11j. Contractor will be required to follow OPSEC procedures as identified in paragraph 2.2(d) of the PWS.
11k. Contractor will be required to use DCS to send and receive classified material. Reference: DoDI 5200.33, June 30, 2011
| addit_sec: | |
| Inspections: Contractor personnel performing OCONUS will be serviced by the Servicing Security Activity (SSA) in the country being visited. | |
| Reset: | |
| 4_Yes: Off | |
| 4_No: No | |
| 5_Yes: Yes | |
| 5_No: Off | |
| 12_Public_Release_Direct: Off | |
| 12_Public_Release_Through: Through. | |
| 13_Rules: | |
| 13_2: | |
| 14_Yes: Off | |
| 14_No: No | |
| 15_Yes: Yes | |
| 15_No: Off | |
| 3_A: Off | |
| 3_B: Off | |
| 3_C: Off | |
| 2017-01-04T15:22:10-0500 | |
| BROADHURST.NATHANIEL.SOLOMON.JR.1045519305 |
13_cont1:
(Extract this continuation page if not required.)
| solic_con1: |
| page1: |
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