Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Hydrochloric and Citric Acid
- Solicitation number
- IFB-26-0146
- 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. This form is designed to control the handling of sensitive documents under 49 C.F.R. Parts 15 and 1520, requiring signatories to protect and ultimately destroy specified documents in compliance with federal regulations. The form mandates that authorized company representatives acknowledge the sensitive nature of the documents, agree to limited disclosure based on "need to know" standards, and commit to destroying the documents upon contract completion or by a specified end date.
The related state and local contract opportunity is an Invitation for Bid (IFB-26-0146) by the City of Phoenix Water Services Department for procuring hydrochloric and citric acid for three wastewater treatment plants. The solicitation seeks multiple acid formulations, including 31.45% hydrochloric acid in 330-gallon totes, 30% hydrochloric acid in 55-gallon drums and 1-gallon containers, and 50% citric acid in 330-gallon totes. The contract includes significant Disadvantaged Business Enterprise (DBE) and small business participation requirements, substantial insurance requirements, and mandates contractors maintain local inventory, provide returnable containers, and submit invoices electronically. The procurement has a five-year term, with estimated annual quantities of 25,000 gallons for hydrochloric acid totes, 550 gallons for 55-gallon drums, 20 gallons for 1-gallon containers, and 25,000 gallons for citric acid totes.
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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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