Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Solicitation number
- RFP GGS-26-0117
- 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 connection with aviation-related contract documentation. The form serves as a compliance document for individuals and companies requiring access to materials containing Sensitive Security Information (SSI) governed by 49 C.F.R. Parts 15 and 1520. Signatories acknowledge that the specified documents may only be disclosed to persons with a demonstrated "need to know" as defined in federal regulations, and they agree to comply with federal security protocols regarding information handling. All recipients must certify their understanding that unauthorized release of such information may result in civil penalties or other legal action.
The form requires authorized representatives to sign and provide company information, committing to the destruction or return of all SSI-controlled documents upon the earlier of the company's completion of its need to review and use the materials or by the contract end date specified. This acknowledgement applies specifically to the City of Phoenix Aviation Department's contract operations and ensures compliance with federal transportation security regulations and public disclosure requirements under 5 U.S.C. 552 and related Code of Federal Regulations provisions.
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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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