Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- 35-65-95 Gallon Containers
- Solicitation number
- RFP 27-SW-001
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department required for access to documents related to an aviation project. The form establishes that specified documents contain Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520 and may only be disclosed to individuals with an established "need to know." Signatories must acknowledge their understanding of these restrictions and agree to comply with federal regulations governing the protection and handling of such information.
The form requires authorized representatives of companies accessing sensitive aviation documents to sign an acknowledgement confirming their obligation to destroy the documents upon the earlier of either completion of their need to review and use the materials or by the contract end date specified in the agreement. Unauthorized disclosure of the information may result in civil penalties or other legal action. The form includes standard fields for company name, authorized representative information, title, contact details, and address, with provisions for filling in specific document titles and contract end dates as applicable to individual procurement actions.
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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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