9-DSA Attachment B Cert Destruction-Return of Data 12.6.21.docx
DOCX document 22 KB Posted
- Attached to
- Chemistry and Honors Chemistry Textbook Adoption
- Solicitation number
- RFP 27003LMK
- Issued by
- Clark County, Nevada
About this file
This is a Certificate of Data Destruction/Return form, Amendment 001 Attachment B, related to a Nevada school district's Chemistry and Honors Chemistry Textbook Adoption contract (27003LMK). The form serves as an official attestation by an authorized representative of the supplier regarding the disposition of district data upon contract completion. The supplier must certify either the destruction or return of all district data provided during the performance of the agreement, with the option to complete both sections if required by the district. The form requires the supplier to specify the destruction or return date, identify any district-approved subcontractors involved, and provide the authorized representative's signature, printed name and title, date, email address, and phone number. The one-year Chemistry and Honors Chemistry course covers structure and properties of matter, chemical reactions, and engineering design, with mandatory demonstrations and laboratory experiences incorporating proper safety techniques, diversity awareness, and technology integration.
The form contains no pricing terms, set-asides, incumbency information, or funding requirements, as it functions solely as a data management compliance document rather than a procurement or pricing instrument. This attachment represents standard data protection and confidentiality procedures required upon contract termination or completion, ensuring that all sensitive district information is either securely destroyed or returned to the district in accordance with the agreement's contractual obligations. The document was created on December 6, 2021.
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Text version
To: Supplier, 27003LMK Chemistry and Honors Chemistry Textbook Adoption 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 .