Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Rotork Actuators
Solicitation number
IFB-26-0140
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department related to a contract opportunity for the purchase of Rotork electric actuators, parts, valves, gearboxes, accessories, and related software. The five-year contract is scheduled to commence on or about February 1, 2026, with the effective date upon award by City Council and signature and recording by the City Clerk's department, as required by Phoenix City Code. The solicitation is available through the City's Procurement Portal, and interested offerors should contact the designated procurement officer for inquiries related to this solicitation.

This form serves to acknowledge and restrict the disclosure of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. Authorized representatives of bidding companies must sign the form, confirming they understand that unauthorized release of the sensitive information may result in civil penalties or other legal action. Recipients agree to destroy all documents containing this controlled information upon the earlier of the company's completion of its need to review and use the documents or by the contract end date. The form requires completion of specific fields including document titles, project name, contract end date, company name, authorized representative information, and company address.

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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

______
TITLEPHONE NUMBER

ADDRESS CITY, STATE AND ZIP CODE

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