15-DSA Attachment B Cert Destruction-Return of Data 12.6.21.docx
DOCX document 19 KB Posted
- Solicitation number
- RFP 27002JBD
- Issued by
- Clark County, Nevada
About this file
This is a Certificate of Data Destruction/Return form for Amendment 001 to a Geoscience and Honors Geoscience Textbook Adoption contract in Nevada. The form serves as an attestation from an authorized supplier representative regarding the handling of district data upon contract completion. The supplier must initial the applicable sections to confirm either destruction or return of all district data provided during contract performance, with specific dates required for documentation. If subcontractors were utilized, the supplier must also certify the destruction or return of data provided to those approved subcontractors, listing their names and the dates of data handling completion.
The form includes two primary options: Part A addresses destruction of district data, while Part B addresses return of district data. The supplier may be required to complete both parts if selected by the district. The certificate requires the authorized representative's signature, printed name and title, date of certification, email address, and phone number. This documentation ensures compliance with the agreement's data protection and confidentiality requirements and serves as proof that the supplier has properly managed sensitive district information in accordance with contractual obligations.
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Text version
To: Supplier, 27002JBD Geoscience and Honors Geoscience Textbook Adoptions Amendment 001 Attachment B Certificate of Data Destruction/Return
I the undersigned serving in the capacity as an authorized representative of the Supplier do hereby represent and warrant (initial next to applicable Parts in sections A and/or B):
Part A – Destruction:
_____ The District Data provided to the Supplier in the performance of the subject Agreement was Destroyed on __________, 20___ in accordance with the Agreement’s requirements.
_____ The District Data provided by the Supplier to its District approved Subcontractor(s) (listed below) in the performance of the subject Agreement was Destroyed on____________, 20____ in accordance with the Agreement’s requirements.
Subcontractor Name(s):_____________________________________________________________________________
Part B – Return: (If selected by the District the Supplier shall also complete Part A) _____ The District Data provided to and/or generated by the Supplier in the performance of the subject Agreement was Returned on ____________, 20_____ in accordance with the Agreement’s requirements.
_____ The District Data provided to and/or generated by the Supplier’s Subcontractor(s) in the performance of the subject Agreement was Returned on _____________, 20_____ in accordance with the Agreement’s requirements.
Supplier:
Signature Authorized Representative:
Print Name and Title:
Date:
Email Address & Phone Number:
V-1 – created 12-6-2021
File details come from the government source that posted it. Updated .