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 opportunities. The form serves as a required acknowledgement that certain documents contain Sensitive Security Information (SSI) controlled under 49 C.F.R. Parts 15 and 1520, restricting disclosure to authorized personnel with a demonstrated need to know. Signatories must acknowledge their understanding of these restrictions and commit to destroying the designated documents upon the earlier of either the company's completion of its need to review and use the materials or the specified contract end date. The form requires completion of blanks identifying the specific document titles, project name, contract end date, and authorized company representative information including printed name, signature, title, phone number, and address.
The acknowledgement form is a standard compliance document unrelated to the primary contract opportunity for Publication of City Charter, City Code, and Zoning Ordinance. Rather, it appears to be a template exhibit for use in aviation-related solicitations where SSI materials may be distributed to bidders. The form's inclusion in the file set suggests that aviation projects handled by the City of Phoenix may require separate security protocols and restricted document handling procedures. Unauthorized release of SSI information carries potential civil penalties and other enforcement actions under federal regulations, making completion and compliance with this acknowledgement form a mandatory prerequisite for any bidder receiving sensitive aviation security documentation from the City.
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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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