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, designed to protect confidential documents related to government contract opportunities. The form requires signatories to understand and comply with federal regulations under 49 C.F.R. Parts 15 and 1520, which govern the handling of sensitive security information. Signatories must agree to destroy specified documents upon completion of their review or by the contract end date, and acknowledge potential civil penalties for unauthorized disclosure.
The related contract opportunity is a five-year solicitation (RFP PS-26-0006) for Occupational Physical Therapy Services targeting municipal employees in Phoenix, Arizona. The contract, valued around $11.5 million based on historical spending, will serve over 16,000 city workers across 35 locations in the Phoenix Metropolitan area. Key procurement details include a non-mandatory pre-offer conference on September 8, 2025, written inquiries due by September 15, 2025, and proposal submissions due October 1, 2025. The evaluation process will assess qualifications, experience, approach, and pricing, with a total possible score of 1,000 points, wherein the fee schedule accounts for 350 points. Prospective contractors must demonstrate at least five years of experience and comply with comprehensive insurance requirements, with the potential contract commencement date set for July 1, 2026, subject to City Council approval.
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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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