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, designed to control access to security-related documents used in aviation projects. The form requires authorized representatives from vendor companies to acknowledge receipt of documents containing Sensitive Security Information regulated under 49 C.F.R. Parts 15 and 1520, and to commit to their destruction upon completion of the contract or by a specified contract end date. The form mandates that only individuals with a documented "need to know" may access the controlled documents, and it explicitly warns that unauthorized disclosure may result in civil penalties or other legal action.
The form serves as a compliance mechanism for federal transportation security regulations and must be completed and signed by an authorized company representative before access to aviation-related contract documents is granted. Signatory information required includes the company name, representative's printed name and signature, title, phone number, and complete address. This acknowledgement is a prerequisite for participation in City of Phoenix Aviation Department contracts and ensures that all parties understand their legal obligations regarding the protection and eventual destruction of sensitive security materials related to airport operations and infrastructure.
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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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