Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
24-Hour Answering Service
Solicitation number
PKS-RFP-27-0440
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 related to a 24-hour call answering service contract. The form is designed to govern the handling of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The City of Phoenix is soliciting sealed offers for 24-hour call answering services under a five-year contract commencing on or about January 1, 2027. The solicitation is available through the City's Procurement Portal, with technical support provided through the OpenGov e-Procurement system. The contract will terminate upon the earliest occurrence of reaching the end of the term including any extensions exercised, or termination pursuant to the provisions of the Agreement. The Effective Date is upon award by City Council, conditioned upon signature and recording by the City Clerk's department as required by the Phoenix City Code.

The Acknowledgement Form requires authorized representatives of companies to acknowledge receipt of sensitive documents and commit to their destruction in compliance with federal regulations upon the earlier of the company's completion of its need to review and use the documents or by the contract end date. Unauthorized release of Sensitive Security Information may result in civil penalties or other legal 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. Signatories must provide their printed name, signature, title, phone number, and complete address. The form serves as a contractual acknowledgement binding both the individual representative and their company to the restrictions on information handling.

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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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