Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Verification of Employment and Income Services
- Solicitation number
- RFP GGS-25-0719
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form for the City of Phoenix Aviation Department, which must be completed by authorized representatives of companies seeking access to security-sensitive documents related to aviation projects. The form establishes compliance requirements for handling Sensitive Security Information governed by 49 C.F.R. Parts 15 and 1520, restricting disclosure to personnel with a demonstrated "need to know." The acknowledgement applies to specific documents identified in the procurement process and requires signatories to commit to destroying the materials upon project completion or by the contract end date, whichever is earlier. All authorized company representatives must complete the form with their printed name, signature, title, phone number, and complete address.
The form serves as a critical prerequisite for participation in aviation-related procurements with the City of Phoenix, ensuring that all bidders and their personnel understand the federal restrictions on Sensitive Security Information and commit to compliance with confidentiality and destruction protocols. Unauthorized disclosure of such information may result in civil penalties or other legal action under federal law and 5 U.S.C. 552. While this particular acknowledgement form is a template, it is directly related to the City of Phoenix's broader procurement activities and reflects the heightened security and compliance standards required for government contracts involving aviation infrastructure and sensitive operational information.
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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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