Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Lower-Level Displays
- Solicitation number
- IFB-PCC-26-0084
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This document is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department. The form is specifically related to the Phoenix Convention Center's project to replace digital signage monitors at the Lower-Level with new LED displays that will integrate with the existing digital signage system. The acknowledgement form requires authorized representatives to recognize the sensitive nature of the documents, which are controlled under specific federal regulations (49 C.F.R. Parts 15 and 1520), and commit to properly handling and ultimately destroying these documents upon project completion or contract end date.
The document does not provide specific pricing details, funding sources, or contract award information. However, it emphasizes strict confidentiality requirements, with potential civil penalties for unauthorized disclosure of the project documents. Signatories must provide their company name, authorized representative's printed name, signature, title, contact information, and full address when completing the form. The form is designed to ensure that sensitive project information is only accessed by individuals with a legitimate "need to know" and is managed in compliance with federal regulations governing information security.
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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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