Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Publication of City Charter, City Code, & Zoning Ordinance
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 solicitations. The form is designed to be completed by authorized representatives of companies receiving access to documents containing Sensitive Security Information (SSI) as controlled under 49 C.F.R. Parts 15 and 1520. Signatories acknowledge their understanding of SSI restrictions, agree that only personnel with a legitimate "need to know" may access the specified documents, and commit to destroying all documents upon the earlier of project completion or a specified contract end date. The form requires completion of company name, authorized representative's printed name and signature, title, phone number, and full address.

The acknowledgement form serves as a compliance mechanism for the City of Phoenix Aviation Department to ensure proper handling and protection of security-sensitive materials distributed during procurement processes. This particular form is unrelated to the concurrent Publication of City Charter, City Code, & Zoning Ordinance solicitation and appears to be a standard template document used when aviation-related procurement activities involve access to sensitive airport security information. Contractors receiving such documents must sign the acknowledgement, understanding that unauthorized disclosure may result in civil penalties or other legal action under federal regulations, and that the City's use of this form aligns with federal transparency and security protocols governing aviation facilities.

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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

______
TITLEPHONE NUMBER

ADDRESS CITY, STATE AND ZIP CODE

File details come from the government source that posted it. Updated .