5-DSA Attachment B Cert Destruction-Return of Data 12.6.21.docx
DOCX document 22 KB Posted
- Attached to
- Physics and Honors Physics Textbook Adoption
- Solicitation number
- RFP 27001BJN
- Issued by
- Clark County, Nevada
About this file
This is a Certificate of Data Destruction/Return form for Amendment 1 of the Physics and Honors Physics Textbook Adoptions contract in Nevada. The document serves as an attestation by an authorized representative of the Supplier regarding the disposition of District Data following performance of the agreement. The form provides two primary options for data handling: Part A covers destruction of District Data provided to the Supplier or its approved subcontractors, with designated spaces to record the destruction date and list any involved subcontractors; Part B addresses return of District Data provided to or generated by the Supplier or its subcontractors, with corresponding spaces for return dates. The Supplier's authorized representative must initial the applicable sections, sign the certificate, and provide their printed name, title, date, email address, and phone number to complete the attestation. The form was created on December 6, 2021.
This document contains no information regarding pricing terms, set asides, incumbents, funding requirements, or other financial details. It is a compliance and data management document designed to ensure proper handling of sensitive District Data upon contract conclusion, requiring the Supplier to confirm either destruction or return of all provided or generated data in accordance with the underlying agreement's requirements.
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Text version
To: Supplier, 27001BJN Physics and Honors Physics Textbook Adoptions – Amendment 1 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 .