Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Custodial Services for Fire Department
Solicitation number
RFP GGS-26-0368
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This is a Sensitive Security Information Acknowledgement Form for the City of Phoenix Aviation Department related to a custodial services contract for the Fire Department. The form serves as a template requiring authorized company representatives to acknowledge receipt of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The acknowledging party agrees to the confidentiality requirements governing these documents and commits to destroying them 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. The form requires signature, printed name, title, phone number, company name, and complete address of the authorized representative.

The Fire Department custodial services contract, issued by the City of Phoenix in Arizona, has a commencement date of August 1, 2027, or upon final signature and recording by the City Clerk's department, whichever is later. The initial contract term is two years, with three one-year renewal options exercisable at the City's sole discretion. Sealed offers are submitted through the City's Procurement Portal, with technical support available through the portal or via procurement-support@opengov.com. The contract will terminate upon reaching the end of the term including any exercised extensions or upon termination pursuant to contract provisions.

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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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