Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Title and Escrow Services
- Solicitation number
- RFP GGS-26-0190
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This file is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department for use in conjunction with aviation-related contract documentation. The form serves to establish compliance with federal security regulations governing sensitive aviation security information controlled under 49 C.F.R. Parts 15 and 1520. The document requires authorized representatives from contractor companies to acknowledge their understanding of information disclosure restrictions, confirm their need-to-know status, and commit to destroying specified documents upon completion of their review and use or by a specified contract end date. Signatories must provide their name, title, company affiliation, phone number, and address.
The form template is designed to be completed with specific document titles and project names as applicable to individual contracts. By executing the acknowledgement, contractors agree to comply with federal security requirements and understand that unauthorized release of sensitive security information may result in civil penalties or other legal action. This acknowledgement mechanism is a standard requirement for contractors accessing aviation security-sensitive materials and demonstrates organizational commitment to federal security protocols applicable to airport and airway operations.
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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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