Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Plastic Signage Material
- Solicitation number
- RFQ-26-0143
- Issued by
- Maricopa County, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department for use in aviation-related procurement activities. The form establishes compliance requirements for individuals and companies accessing documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. Authorized representatives must acknowledge their understanding of disclosure restrictions, recognize that unauthorized release may result in civil penalties or other legal action, and commit to destroying the documents upon the earlier of project completion or a specified contract end date. The form requires completion with the document title(s), project name, contract end date, company name, authorized representative signature, title, phone number, and full address.
The acknowledgement form serves as a prerequisite control mechanism for the City of Phoenix's plastic signage material procurement, a five-year contract commencing on or about April 1, 2026. This form ensures that all parties with access to aviation-sensitive materials understand their legal obligations regarding information security and document handling. The requirement reflects federal aviation security protocols and protects the City's compliance with federal regulations governing the protection of sensitive security information in airport and aviation operations.
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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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