Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Solicitation number
- RFP PTD26-004
- 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 documentation. The form serves as a template for contractors and their representatives to acknowledge receipt of documents containing Sensitive Security Information (SSI) as defined under 49 C.F.R. Parts 15 and 1520. Signatories agree to limit disclosure of the identified documents only to authorized personnel with a demonstrated "need to know" and commit to destroying the documents upon the earlier of project completion or the contract end date. The form requires the authorized company representative to provide their printed name, signature, title, phone number, and complete address before submitting the acknowledgement.
The form is governed by federal aviation security regulations and restrictions on public disclosure under 5 U.S.C. 552 and the Code of Federal Regulations. Unauthorized release of Sensitive Security Information may result in civil penalties or other legal action. While the acknowledgement form references a related contract opportunity for North and South Transit Facilities Fixed Route Services with a commencement date of July 1, 2027, and a five-year term with one optional two-year renewal period, the specific documents subject to SSI protection and their exact titles are not completed in this template. The form is designed to be executed prior to sharing restricted aviation security information with prospective bidders or contractors involved in City of Phoenix projects.
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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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