Attachment_8.4_-__DD254_(draft).pdf

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Chemical, Biological, Radiological and Nuclear (CBRN) Response and Training - W9124J-16-R-0024
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W9124J-15-R-0024
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Attachment 8.4 - DD Form 254 (DRAFT)

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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. AND SAFEGUARDING

a. CLEARANCE REQUIRED

b. LEVEL OF SAFEGUARDING REQUIRED

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

a. CONTRACT NUMBER

b. SUBCONTRACT NUMBER

c. DUE DATE (YYYYMMDD)

3. IS: (X and complete as applicable)

a. (Complete date in all cases)

REVISION NO.

c. (Complete Item 5 in all cases)

DATE (YYYYMMDD)

b. REVISED (Supersedes all previous specs)

DATE (YYYYMMDD)

DATE (YYYYMMDD)

4. THIS A FOLLOW-ON CONTRACT? YES NO. Yes, complete the following:

Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract.

5. THIS A FINAL DD FORM 254? YES NO. Yes, complete the following:

In response to the contractor's request dated , retention of the classified material is authorized for the period of

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

a. ADDRESS, AND ZIP CODE b. CAGE CODE c. SECURITY OFFICE (Name, Address, and Zip Code)

7.

a. ADDRESS, AND ZIP CODE b. CAGE CODE c. SECURITY OFFICE (Name, Address, and Zip Code)

8. PERFORMANCE

a. b. CAGE CODE c. SECURITY OFFICE (Name, Address, and Zip Code)

9. 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.

g. NATO INFORMATION

h. FOREIGN GOVERNMENT INFORMATION

i. LIMITED DISSEMINATION INFORMATION

j. FOR OFFICIAL USE ONLY INFORMATION

k. (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. 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. (Specify)

CLEARANCE

FACILITY

THIS SPECIFICATION

PRIME

SOLICITATION OR OTHER NUMBER

THIS SPECIFICATION

ORIGINAL

FINAL

IS If

IS If

CONTRACTOR

NAME, COGNIZANT

SUBCONTRACTOR

NAME, COGNIZANT

ACTUAL

LOCATION COGNIZANT

GENERAL

SPECIAL ACCESS INFORMATION

OTHER

HAVE

OTHER

DD FORM 254, DEC 1999 PREVIOUS EDITION IS OBSOLETE.

12. 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.

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. 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. 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. 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. questions shall be referred to the official named below.

b. TITLE c. (Include Area Code) e.

17. 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.

PUBLIC

TYPED NAME OF CERTIFYING OFFICIAL

SECURITY GUIDANCE.

ADDITIONAL SECURITY REQUIREMENTS.

INSPECTIONS.

All

TELEPHONE

SIGNATURE

REQUIRED

OTHERS AS NECESSARY

DD FORM 254 (BACK), DEC 1999

a_FACILITY_CLEARANCE_REQU: SECRET
b_LEVEL_OF_SAFEGUARDING_R: NONE
FillText1: Off
a_PRIME_CONTRACT_NUMBER:
DATE_YYYYMMDD:
FillText3: Off
b_SUBCONTRACT_NUMBER:
REVISION_NO:
DATE_YYYYMMDD1:
FillText5: Off
c_SOLICITATION_OR_OTHER_N: W9124J-16-R-0024
DUE_DATE_YYYYMMDD: 20160526
DATE_YYYYMMDD2:
YES1: W9124J-16-R-0024
FillText12:
FillText11:
a_NAME_ADDRESS_AND_ZIP_CO:
b_CAGE_CODE:
c_COGNIZANT_SECURITY_OFFI:
a_NAME_ADDRESS_AND_ZIP_C1:
b_CAGE_CODE1: N/A
c_COGNIZANT_SECURITY_OFF1:
a_LOCATION: ARNORTH, 2108 Wilson Way, Ft. Sam Houston, TX 78234

U.S. Northern Command, 250 Vandenburg, Bldg 2, Peterson AFB, CO 80914-6889

b_CAGE_CODE2: N/A
c_COGNIZANT_SECURITY_OFF2:
9_GENERAL_IDENTIFICATION:
a_COMMUNICATIONS_SECURIT1: Off
a_COMMUNICATIONS_SECURIT2: Yes
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: Off
1_Sensitive_Compartmente2: Yes
2_NonSCI1: Off
2_NonSCI2: Yes
f_SPECIAL_ACCESS_INFORMA1: Off
f_SPECIAL_ACCESS_INFORMA2: Yes
g_NATO_INFORMATION1: Off
g_NATO_INFORMATION2: Yes
h_FOREIGN_GOVERNMENT_INF1: Off
h_FOREIGN_GOVERNMENT_INF2: Yes
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: Off
c_CRITICAL_NUCLEAR_WEAPO4: Yes
d_FORMERLY_RESTRICTED_DA3: Off
d_FORMERLY_RESTRICTED_DA4: Yes
e_INTELLIGENCE_INFORMATI3: Off
e_INTELLIGENCE_INFORMATI4: Yes
1_Sensitive_Compartmente3: Off
1_Sensitive_Compartmente4: Yes
2_NonSCI3: Off
2_NonSCI4: Yes
f_SPECIAL_ACCESS_INFORMA3: Off
f_SPECIAL_ACCESS_INFORMA4: Yes
g_NATO_INFORMATION3: Off
g_NATO_INFORMATION4: Yes
h_FOREIGN_GOVERNMENT_INF3: Off
h_FOREIGN_GOVERNMENT_INF4: Yes
i_LIMITED_DISSEMINATION_3: Off
i_LIMITED_DISSEMINATION_4: Yes
1_OTHER_Specify:
FillText13: Off
FillText14: Off
a_TYPED_NAME_OF_CERTIFYIN: Casey Gates
b_TITLE: G2 Command Security Advisor
c_TELEPHONE_Include_Area: 221-221-1909
d_ADDRESS_Include_Zip_Cod: 2108 Wilson Way

Fort Sam Houston, TX 78234

FillText21: Yes
FillText22: Off
FillText23: Yes
FillText24: Off
FillText25: Yes
FillText26: Yes
f_OTHERS_AS_NECESSARY:
FillText15:
FillText16:
other1:
release: Any public release of information must be coordinated with the COR and ARNORTH G3/5/7 for OPSEC review and released by the ARNORTH PAO office.
security: The Contractor requires a SECRET facility clearance with NO

safeguarding from the Defense Security Service for full time employees and Incident Commanders (part time employees, under key personnel, para 1.6.11.1.1). The Contractor will require access to FOUO information. The Contractor will perform only at US government facilities including:

Ft. Sam Houston, TX and Peterson AFB, Colorado, Springs, CO. These employees are exposed to classified information pertaining to the DOD's CBRN Enterprise on government installations. They do not require computer network support for classified information.

ARNORTH COR

addit_sec:
Inspections:
Reset:
4_Yes: Off
4_No: No
5_Yes: Off
5_No: No
12_Public_Release_Direct: Off
12_Public_Release_Through: Through.
13_Rules:
13_2:
14_Yes: Off
14_No: No
15_Yes: Off
15_No: No
3_A: Off
3_B: Off
3_C: Off

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