Attachment_4_-_DD254.pdf
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- Attached to
- Installation Support Services for Yuma Proving Ground, AZ Federal contract opportunity
- Solicitation number
- W9124R-15-R-0001
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DD254
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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. Adobe Professional X
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 classification 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
| fac_clear: SECRET |
| safe_level: NONE |
| prime_no: W9124R-15-R-0001 |
| xprime: Yes |
| sub_no: |
| xsub: Off |
| xsolic: Off |
| solic_no: |
| due_date: |
| xspec3: Off |
| orig_date: |
| rev_no: |
| rev_date: |
| final_date: |
| xfollowon: No |
| prec_no: |
| xfinal: No |
| req_dated: |
| period: |
| ctr_name: FOR PLANNING PURPOSES ONLY |
| ctr_cage: |
| ctr_ofc: FOR PLANNING PURPOSES ONLY |
| sub_name: |
| sub_cage: |
| sub_ofc: |
| perf_loc: |
| perf_cage: |
| perf_ofc: |
| gen_id: Provide Installation Support Services (ISS) for the Directorate of Public Works (DPW) in support of IMCOM and USAYPG mission goals |
| x10a: No |
| x10b: No |
| x10c: No |
| x10d: No |
| x10e1: No |
| x10e2: No |
| x10f: No |
| x10g: No |
| x10h: No |
| x10i: No |
| x10j: Yes |
| x10k: Yes |
| other10k: Controlled Unclassified Information (CUI) |
| x11a: Yes |
| x11b: No |
| x11c: No |
| x11d: No |
| x11e: Yes |
| x11f: No |
| x11g: No |
| x11h: No |
| x11i: No |
| x11j: Yes |
| x11k: No |
| x11l: No |
| other11l: |
| xrelease: No |
| release_thru: COMMANDER, U.S. ARMY YUMA PROVING GROUND; ATTN: TEDT-YP-PLI; 301 C STREET; YUMA, AZ 85365-9498 |
| guidance: 10j. FOUO information generated and/or provided under this contract shall be safeguarded and marked as specified in the DoDM 5200.01 Vol4, Encl. 3 and in Attachment 1 - "Protecting FOUO information." |
10k. CONTROLLED UNCLASSIFIED INFORMATION (CUI): CUI generated and/or provided under this contract shall be safeguarded and marked as specified in the DoDM 5200.01 Vol4, Encl. 3.
11a. All classified services rendered in performance of this contract will be conducted at facilities approved by the government Cognizant Security Agency (CSA).
11e. Equipment Maintenance Services: Contract is in part for equipment maintenance services on equipment which may possess classified information. Actual knowledge of, generation, or production of classified information is not required for performance of this contract. Cleared personnel are required to perform this service because access to classified information cannot be precluded by escorting personnel.
11j. OPERATIONS SECURITY (OPSEC): OPSEC requirements are outlined in the PWS. In addition, all UNCLASSIFIED materials must receive approval from the YPG Intelligence and Security Office and YPG Public Affairs Office prior to being released to the public. Requests for public release shall be submitted five (5) working days in advance.
The undersigned has reviewed this Security Specification, understands the provisions and will ensure that it is complied with within the limits of his/her responsibility, and that any violations are brought to the attention of the KO and supporting Security Manager.
COR's name to go here
| xaddlsec: Yes |
| addl_sec: The contractor may award subcontracts in furtherance of this effort. If access to classified information is required, the prime contractor is responsible to ensure compliance by the subcontractor for all security requirements. Copies of the DD254 shall be forwarded to the Contracting Officer and YPG Intelligence and Security Office at the address listed in block 16d. |
| xinsp: No |
| inspections: |
| cert_name: JACKI DUMAS |
| cert_title: SECURITY SPECIALIST |
| cert_phone: 928-328-3202 |
| cert_addr: ATTN: TEDT-YP-PLI; |
301 C STREET
YUMA, AZ 85365-9498
| x17a: Yes | |
| x17b: Off | |
| x17c: Yes | |
| x17d: Off | |
| x17e: Yes | |
| x17f: Off | |
| other_dist: | |
| 2015-04-09T10:14:36-0700 | |
| DUMAS.JACKI.LIN.1013840683 |
File details come from the government source that posted it. Updated .