Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Part-Time Television Engineering Services
- Solicitation number
- IFB-26-0141
- 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 with a part-time television engineering services contract. The form is required for all individuals and organizations with access to sensitive security information controlled under 49 C.F.R. Parts 15 and 1520 related to the five-year contract commencing on or about May 16, 2026. The contract is being solicited through the City's Procurement Portal, with technical support available through the portal's support bubble or at procurement-support@opengov.com. The agreement will terminate upon the earlier of reaching the end of the contract term, including any extensions exercised, or upon termination pursuant to the agreement's provisions.
Signatories to this acknowledgement form must confirm their understanding that the sensitive security information contained within specified documents may only be disclosed to persons with a demonstrated "need to know" as defined in federal regulations. Unauthorized release of this information may result in civil penalties or other legal action. Upon signature, authorized company representatives agree to destroy all designated documents in compliance with 49 C.F.R. Parts 15 and 1520, either upon completion of their review and use of the documents or by the contract end date, whichever occurs first. For U.S. government agencies, public disclosure of such information is governed by 5 U.S.C. 552 and the aforementioned federal regulations.
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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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