Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Materials Recovery Facility Maintenance & Inspection Program
Solicitation number
RFP 27-SW-009
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This is a Sensitive Security Information Acknowledgement Form used by the City of Phoenix Aviation Department to control disclosure of security-sensitive documents related to aviation projects. The form requires authorized representatives from bidding companies to acknowledge receipt of documents containing Sensitive Security Information (SSI) governed by 49 C.F.R. Parts 15 and 1520. Signatories agree that the information may only be accessed by personnel with a demonstrated "need to know" and commit to destroying all documents upon the earlier of either completion of their review and use or by the contract's end date. Unauthorized disclosure of this information may result in civil penalties or other legal action. The form requires completion of blank fields identifying specific document titles and project names, as well as the authorized representative's name, title, signature, phone number, and company address.

This acknowledgement form is a procedural requirement for participation in the Materials Recovery Facility Maintenance & Inspection Program solicitation issued by the City of Phoenix in Arizona. While the related contract opportunity calls for a three-year base term with two optional one-year extensions commencing September 1, 2026, the acknowledgement form serves as a prerequisite control document for any bidders who will receive SSI materials during the procurement process. The form ensures compliance with federal aviation security regulations and establishes accountability for all parties handling sensitive facility information related to the materials recovery facility project.

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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

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