Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Print and Mail Election Materials
- Solicitation number
- RFP GGS-26-0079
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department for use in conjunction with a project involving documents controlled under 49 C.F.R. Parts 15 and 1520. The form requires authorized representatives from contractor companies to acknowledge receipt of sensitive security information related to aviation operations and to commit to proper handling and destruction of such documents. Signatories must provide their name, title, company affiliation, phone number, and address. The form specifies that documents may only be disclosed to individuals with a demonstrated "need to know" as defined under federal aviation security regulations, and unauthorized release may result in civil penalties or other legal action. Upon completion of the contractor's review and use of the documents, or by the contract end date (whichever is earlier), the contractor agrees to destroy all sensitive security information in full compliance with applicable federal regulations.
The acknowledgement form serves as a compliance mechanism to protect sensitive aviation security information from unauthorized disclosure in government contracts. While the form itself does not contain pricing terms, specific funding amounts, or contract award details, it functions as a required exhibit within a larger procurement package. Organizations bidding on City of Phoenix Aviation Department contracts involving this form must ensure that authorized personnel understand their obligations under federal security regulations and are prepared to execute proper document destruction protocols. The form's emphasis on federal regulatory compliance (49 C.F.R. Parts 15 and 1520) and alignment with government disclosure rules (5 U.S.C. 552) indicates that this document pertains to aviation infrastructure or operations of significant security sensitivity.
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Text version
EXHIBIT __
City of Phoenix Aviation Department Sensitive Security Information Acknowledgement Form
The documents entitled [fill in document title(s)] (“Documents”) to be used as part of the [fill in project name] contain Sensitive Security Information that is controlled under 49 C.F.R. Parts 15 and 1520. These documents may only be disclosed to persons who have the requisite “need to know”, as defined in 49 C.F.R. Parts 15 and 1520. Unauthorized release of this information may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 C.F.R. Parts 15 and 1520.
I acknowledge, on my behalf and that of my company, the above statement and agree to destroy the [fill in document title(s)], in compliance with 49 C.F.R. Parts 15 and 1520, upon the earlier of our company’s completion of our need to review and/or use the Documents or no later than [fill in current contract end date].
NAME OF COMPANY
AUTHORIZED REPRESENTATIVE PRINTED NAME
AUTHORIZED REPRESENTATIVE’S SIGNATURE
| ______ | ||
| TITLE | PHONE NUMBER |
ADDRESS CITY, STATE AND ZIP CODE
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