8-Cert Destruction-Return of Data - Attachment B 12.6.21.docx
DOCX document 20 KB Posted
- Attached to
- RFP 26024BDC Grades 6-12 Digital Courseware
- Solicitation number
- RFP 26024BDC
- Issued by
- Clark County, Nevada
About this file
This is a Certificate of Data Destruction/Return form issued by a Nevada school district for RFP 26024BDC regarding Grades 6-12 Digital Courseware services under a Data Sharing Agreement. The document serves as an attestation by an authorized supplier representative confirming compliance with data handling requirements upon contract completion. The form is designed to document either the destruction or return of district data provided to or generated by the supplier during performance of the agreement, with provisions for identifying any district-approved subcontractors involved in data handling activities. The certificate requires specification of destruction or return dates, subcontractor names where applicable, and authorized signature with printed name, title, contact information, and date of certification.
The document contains two alternative completion paths: Part A addresses data destruction with dated confirmation of when district data was destroyed in accordance with agreement requirements, while Part B addresses data return with dated confirmation of when data was returned to the district. If the district elects data return, Part A must also be completed. The form accommodates both direct supplier actions and those performed by approved subcontractors, with separate line items for certifying compliance at each level. This certificate version was created on December 6, 2021, and represents a standard administrative requirement for contract closeout ensuring proper handling and security of sensitive educational data.
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Other files
| File | Type | Posted |
|---|---|---|
| 13-RFP 26024BDC Grades Digital Courseware.doc | DOC document | |
| 5-W-9.pdf | ||
| 6-Supplier Application Update Form.doc | DOC document | |
| 3-Supplier Federal 2 CFR 200 Certification Form.docx | DOCX document | |
| 7-Supplier Contact List Designation Form.doc | DOC document | |
| 1-Public Disclosure Form.docx | DOCX document | |
| 12-RFP26024BDC Appendix A Pricing Sheet.docx | DOCX document | |
| 2-Customer Reference Form.docx | DOCX document | |
| 9-Data Share Amendment.docx | DOCX document | |
| 10-DSA Schedule of Data Attachment A 7-17-25.docx | DOCX document | |
| 11-Appendix B Systems Matrix.xlsx | XLSX spreadsheet | |
| 4-Proposal Submittal Form.doc | DOC document |
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Text version
To: Supplier, Data Sharing Agreement RFP 26024BDC 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 .