Contractor Security Acknowledgement Form 2022_.docx

DOCX document 69 KB Posted

Attached to
Statewide Trauma Registry
Solicitation number
24RFP25-0902006-003
Issued by
Brown County, South Dakota

About this file

This document is a Contractor Security Acknowledgement Form required for a contract between the State of South Dakota and a contractor. The contractor agrees to comply with the State's Information Technology Security Policy, including protecting the State's technology and information assets, following confidentiality and data handling regulations, and promptly reporting any policy violations. Access to the State's technology infrastructure is considered a privilege that may be revoked, and access automatically terminates upon contract termination.

The related state and local contract opportunity is for the South Dakota Department of Health to contract with a consultant to provide a statewide trauma registry. The registry must be capable of collecting data from 49 hospitals, generating reports, and accepting EMS data. Offerors may submit inquiries for clarification, and the State will respond via email and post on the e-procurement system. No late inquiries will be accepted.

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Text version

Contractor Agreement to Comply with BIT Information Technology Security Policy

Please return agreement to your designated BIT Contact

Pursuant to the terms of the Agreement between the Contractor and the State, the Contractor is required to sign this Contractor Agreement to Comply with the BIT Information Technology Security Policy (the “Policy”) on behalf of its current and future employees who will be responsible for fulfilling the requirements of the Agreement. The Contractor is responsible for ensuring that each Contractor employee complies with all information security policies and procedures found within the Policy. By signature below, the Contractor hereby acknowledges and agrees to the following:

1. In providing services under a contract, the Contractor will use non-public State of South Dakota technology infrastructure or information;

2. The Contractor will protect technology and information assets of the State from unauthorized activities including but not limited to access, disclosure, modification, deletion, and usage;

3. The Contractor agrees to follow state and federal regulations in regard to confidentiality and handling of data;

4. The Contractor has read and agrees to abide by the Policy, which is attached to the Agreement;

5. The Contractor will discuss with a state contact any violation of the Policy;

6. The Contractor understands that any individual found to have violated the Policy is subject to privilege revocation and, at the State’s discretion, may be considered a breach of the Agreement with the State;

7. Access to the technology infrastructure of the State or the State’s information is a privilege which may be changed or revoked at the discretion of BIT management;

8. Access to the technology infrastructure of the State automatically terminates upon contract termination unless otherwise agreed upon in writing by the parties; and

9. The Contractor shall promptly report violations of the Policy to the State Contact and BIT Help Desk (605-773-4357).

Acknowledgement: State of South Dakota Information Technology Security Policy

Contractor: The individual signing this form on behalf of their entire company affirms that he/she has the authority to commit the Contractor and all its employees to follow the terms of this agreement.

Contractor Signature Date BIT Contact Date

Printed Contractor name and Company name

BIT Attachment 2

Revised 2022 image1.png image2.png image3.png image4.png image5.png

File details come from the government source that posted it. Updated .