Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Occupational Physical Therapy Services State and local contract opportunity
- Solicitation number
- RFP PS-26-0006
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
The document is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department. The form is related to an occupational physical therapy services contract for a five-year term beginning approximately July 1, 2026, with the potential start date being upon City Council award. The solicitation is available through the City's Procurement Portal, and technical support for the OpenGov e-Procurement Portal is provided via an online support bubble or email. The contract will terminate upon reaching the end of its term, including any potential extensions, or through other specified termination provisions.
The acknowledgement form emphasizes strict handling of sensitive security information controlled under federal regulations (49 C.F.R. Parts 15 and 1520), requiring signatories to limit document disclosure to persons with a requisite "need to know" and mandating document destruction upon contract completion or by the specified contract end date. While specific pricing details are not included in this document, the form is part of the procurement process for occupational physical therapy services in Phoenix, Arizona, and requires authorized company representatives to formally acknowledge and comply with sensitive information handling protocols.
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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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