Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Bus Stop and Transit Center Cleaning Services
Solicitation number
PTD26-006
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 to restrict access to documents containing sensitive security information governed by 49 C.F.R. Parts 15 and 1520, limiting disclosure to authorized personnel with a demonstrated need to know. Signatories acknowledge their understanding of these restrictions and agree to comply with federal regulations regarding the handling and safeguarding of such materials. The form requires completion of specific fields including document titles, project names, contract end dates, and authorized representative information.

The form applies to a separate Bus Stop and Transit Center Cleaning Services solicitation issued by the City of Phoenix, with an agreement term of five years commencing January 1, 2027 or upon the Effective Date, whichever is later. The agreement contains no extension options and will terminate upon the earlier of the end of the five-year term or upon termination pursuant to agreement provisions. Sealed offers are being accepted through the City's Procurement Portal. Contractors receiving access to sensitive security information must acknowledge the confidentiality requirements and commit to destroying all documents upon the earlier of completion of their need to review the materials or the contract end date, in compliance with applicable federal regulations.

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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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