Attachment_5_DD_Form_254.pdf

DEPARTMENT OF DEFENSE 1. CLEARANCE AND SAFEGUARDING

CONTRACT SECURITY CLASSIFICATION SPECIFICATION a. FACILITY CLEARANCE REQUIRED

SECRET

(The requirements of the DoD Industrial Security Manual apply b. LEVEL OF SAFEGUARDING REQUIRED to all aspects of this effort) None

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

a. PRIME CONTRACT NUMBER a. ORIGINAL (Complete date in all cases) Date (YYYYMMDD)

□ C8J 20180829

b. SUBCONTRACT NUMBER b. REVISED (Supersedes

I Revision No. Date (YYYYMMDD) all previous specs)

c. SOLICITATION OR OTHER NUMBER

I Due Date (YYYYMMDD) c. FINAL (Complete Item 5 in all cases) Date (YYYYMMDD)

C8J W912CM-18-Q-00XX □

4. IS THIS A FOLLOW-ON CONTRACT? l..Q__J YES � NO. If Yes complete the following

5. IS THIS A FINAL DD FORM 254? l..Q__J YES � NO. If Yes complete the following

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)

"FOR PLANNING PURPOSES ONLY"

7. SUBCONTRACTOR

a. NAME, ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICES / Name, Address, and Zip Code)

8. ACTUAL PERFORMANCE

b. CAGE CODE

WND1X1

c. COGNIZANT SECURITY OFFICE (Name. Address, and Zip Code)

66MI BDE, S2

Unit 29500 Box 11

ATTN: SSO

APO AE 09005

a. LOCATION

66 MI BDE

Lucius D. Clay Kaserne 65205 Wiesbaden-Erbenheim Germany

9. GENERAL IDENTIFICATION OF THIS PROCUREMENT

The requirement is to provide four (4) Deployable Secure Containers to be delivered to Wiesbaden-Erbenheim, Germany.

All work performed in the design, engineering, manufacturing, assembly, and transportation of the containers under this contract shall be performed in a United States (U.S.) controlled facility in the United States of America (USA), by U.S.

companies using U.S. persons.

10. THIS CONTRACT WILL REQUIRE ACCESS TO: YES NO 11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL: YES NO

a. COMMUNICATIONS SECURITY (COMSEC) □ cgi a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT ANOTHER cgi □

INFORMATION CONTRACTOR'S FACILITY OR A GOVERNMENT ACTIVITY

b. RESTRICTED DATA □ cgi b. RECEIVE CLASSIFIED DOCUMENTS ONLY □ cgi

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION □ cgi c. RECEIVE AND GENERATE CLASSIFIED MATERIAL □ cgi

d. FORMERLY RESTRICTED DATA: □ cgi d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE □ cgi

e. INTELLIGENCE INFORMATION: e. PERFORM SERVICES ONLY □ cgi

(1) Sensitive Compartmented Information (SCI) □ cgi f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE THE U.S., PUERTO □ cgi RICO. U.S. POSSESSIONS AND TRUST TERRITORIES

(2) Non-SCI cgi □ g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL □ cgi INFORMATION CENTER <DTIC\ OR OTHER SECONDARY DISTRIBUTION CENTER

f. SPECIAL ACCESS INFORMATION □ cgi h. REQUIRE A COMSEC ACCOUNT □ cgi g NATO INFORMATION □ cgi i. HAVE A TEMPEST REQUIREMENT □ cgi

h. FOREIGN GOVERNMENT INFORMATION □ cgi j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS □ cgi

i. LIMITED DISSEMINATION INFORMATION □ cgi k. BE AUTHORIZED TO USE THE DEFENSE COURIER SERVICE □ cgi

j. FOR OFFICIAL USE ONLY INFORMATION cgi □ I. LOTHER /Specify). □ cgi

k. OTHER Specify) SIPRNET Access cgi □

DD Form 254, DEC 1999 Previous editions are 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 release shall be submitted for approval prior to release

[DJ Direct � Through (Specify):

Proposed public release shall be submitted for approval prior to release 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 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 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 document/guides/extracts referenced herein.

Add additional pages as needed to provide complete guidance.

SEE SECTION 13 CONTINUATION SECTION AT THE BOTTOM OF THIS FORM

8/29/2018

Angel Mangualsalas, GG13 Special Security Officer

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.)

15. 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.

l9 Yes

No

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

Special Security Officer /Industrial Security

Officer

a. TYPED NAME OF CERTIFYING OFFICIAL

Angel Mangualsalas

d. ADDRESS (Include ZIP Code)

66MI BDE, S2

Unit 29500

ATTN: IAPG-SE

09005

e. SIG!\Jf-TURE

DD Form 254 (BACK), DEC 1999

c. TELEPHONE (Include Area Code)

314-546-4206

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

f. OTHERS AS NECESSARY

XXX