SECTION_J_Attachment_05 _DD_254.pdf

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NGB Facility Maintenance and Repair
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W9133L-16-R-0077
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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:
xprime: Off
sub_no:
xsub: Off
xsolic: Yes
solic_no: W9133L-09-F-0XXX
due_date:
xspec3: Orig
orig_date:
rev_no:
rev_date:
final_date:
xfollowon: No
prec_no:
xfinal: Off
req_dated:
period:
ctr_name: TBD
ctr_cage:
ctr_ofc:
sub_name: N/A
sub_cage:
sub_ofc:
perf_loc: CHIEF OF STAFF - ARLINGTON HALL STATION

NATIONAL GUARD BUREAU

111 S. GEORGE MASON DRIVE

ARLINGTON, VIRGINIA 22204-1382

perf_cage:
perf_ofc: AHS PERSONNEL SECURITY BRANCH

NATIONAL GUARD BUREAU

111 S. GEORGE MASON DRIVE

ARLINGTON, VIRGINIA 22204-1382

gen_id:
x10a: No
x10b: No
x10c: No
x10d: No
x10e1: No
x10e2: No
x10f: No
x10g: No
x10h: No
x10i: No
x10j: Yes
x10k: No
other10k:
x11a: No
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: PUBLIC AFFAIRS OFFICER

111 S. GEORGE MASON DRIVE

ARLINGTON, VIRGINIA 22204-1382

guidance: -11.(e): Contract is for facility maintenance services on equipment in areas which possess classified information. Actual knowledge of, generation, or production of classified information is not required for performance of the contract. Cleared personnel are required to perform this service because access to classified information can not be precluded by escorting personnel. Any classification guidance needed will be provided by the using contractor.

-11.(j): Operations Security (OPSEC) protection for classified and sensitive unclassified information (as defined in Public Law 100-236, 9 January 1988) developed or used in performance of this contract. OPSEC requirements are contained in National Security Decision Directive 298 dated 23 January 1988 and Army Regulation 530-1. The project officer will forward these under separate cover.

-Visit requests to activities other than those not listed in the statement of work or this DD 254 shall have "Need to Know" certified by the Project Officer. All requests shall contain the information required by the NISPOM and shall not exceed a 12 month period.

-All Government Badges issued under this contract will be returned immediately upon termination of the contract, or individual terminations. When an individual contractor is terminated, for any reason, it is the responsibility of the Facility Security Officer to immediately notify the Provost Marshall's Office. Failure to comply could result in the suspension of all contractor proximity key and NT accounts.

xaddlsec: No
addl_sec:
xinsp: No
inspections:
cert_name:
cert_title:
cert_phone:
cert_addr: NATIONAL GUARD BUREAU

ATTN AHS PERSONNEL SECURITY BRANCH

111 S. GEORGE MASON DR, ARLINGTON, VA 22204-1382

x17a: Yes
x17b: Off
x17c: Yes
x17d: Off
x17e: Yes
x17f: Off
other_dist:

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