Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
FMLA and PPL Administration Service
Solicitation number
RFP PS-26-0173
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 that establishes protocols for handling restricted security documentation related to a contract project. The form requires authorized representatives from companies receiving sensitive security information to acknowledge their understanding of disclosure restrictions governed by 49 C.F.R. Parts 15 and 1520, which control sensitive aviation security materials. Signatories agree to limit document access to personnel with a legitimate "need to know" and commit to destroying all received documentation upon the earlier of either project completion or a specified contract end date. The form serves as a binding acknowledgement that unauthorized release of the information may result in civil penalties or other legal action.

The form is presented as a template requiring completion with specific document titles, project names, and contract end dates to be inserted as applicable. It must be signed by an authorized company representative and includes fields for the representative's printed name, title, phone number, and company address. While this acknowledgement form is referenced in the related City of Phoenix FMLA and PPL Administration Services contract opportunity, the sensitive security information requirements indicated by this form suggest that certain procurement documents or project details may contain restricted aviation security information requiring controlled dissemination, though the FMLA and PPL Administration Services contract itself does not typically involve aviation security matters.

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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 .