Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Chlorine
- Solicitation number
- IFB-26-0153
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department for use in connection with a chlorine supply contract. The form establishes the confidentiality requirements and handling procedures for sensitive security information controlled under 49 C.F.R. Parts 15 and 1520. The City of Phoenix issued a sealed bid solicitation for chlorine under a five-year contract with an effective date on or about February 1, 2026, contingent upon City Council award and signature and recording by the City Clerk's department. The contract will terminate upon the earliest occurrence of reaching the end of the term including any extensions exercised or termination pursuant to agreement provisions.
The Sensitive Security Information Acknowledgement Form requires authorized representatives of bidding companies to acknowledge and agree to the confidentiality restrictions governing the documents provided as part of the solicitation. Signatories must commit to destroying all documentation containing sensitive security information upon the earlier of the company's completion of its need to review and use the documents or no later than the current contract end date. Unauthorized release of sensitive security information may result in civil penalties or other legal action. For technical support related to the City's Procurement Portal, offerors may contact procurement-support@opengov.com. The procurement officer listed under Contact Information should be contacted for other issues related to the solicitation.
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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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