Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Laboratory-Grade Steam Sterilizer – Supply, Installation, Maintenance, Calibration, and Repair Services
- Solicitation number
- RFQ-27-0463
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form related to the City of Phoenix's solicitation for laboratory-grade steam sterilizer supply, installation, maintenance, calibration, and repair services in Arizona. The form establishes the procedures and requirements for handling sensitive security information in connection with this procurement opportunity. Offerors and their representatives are required to acknowledge and comply with security protocols regarding access to, use of, and protection of any sensitive security information disclosed during the solicitation process. The five-year contract term commences on a date to be specified by Phoenix City Council, with no renewal or extension options available beyond the initial five-year period.
The acknowledgement form serves as a prerequisite for participation in this procurement and requires authorized signatories to certify their understanding of security obligations and restrictions. Specific pricing terms, set-asides, funding sources, and other financial details are not addressed in this security acknowledgement document. Offerors must complete and submit this form as part of their sealed offer package through the City of Phoenix's Procurement Portal, with technical support available through the portal's support function or at procurement-support@opengov.com.
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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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