Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Event Equipment Rental Services
- Solicitation number
- PKS-IFB-26-0175
- 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 conjunction with the Event Equipment Rental Services contract opportunity. The form is designed to control access to documents containing Sensitive Security Information as defined under 49 C.F.R. Parts 15 and 1520. The acknowledgement form requires authorized company representatives to sign and affirm their understanding of restrictions on document disclosure, limiting access to individuals with a demonstrated "need to know." Signatories agree to comply with federal regulations governing the handling of sensitive aviation security information and commit to destroying the controlled documents upon the earlier of project completion or the contract end date specified in the award.
The form serves as a mandatory compliance mechanism for the City of Phoenix's Event Equipment Rental Services solicitation, a five-year contract commencing on or about April 1, 2026. Offerors participating in this opportunity must complete and execute the acknowledgement form, providing company name, authorized representative information, signature, title, phone number, and complete address. Unauthorized disclosure of the controlled information may result in civil penalties or other legal action. The form contains blank fields to be completed with specific document titles and contract end dates at the time of contract award.
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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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