Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Bypass Spools and Tailpieces
- Solicitation number
- IFB-26-0112
- 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 state and local contract opportunity. The document serves as a template requiring authorized representatives from bidding companies to acknowledge receipt and understanding of sensitive security information controlled under 49 C.F.R. Parts 15 and 1520. Signatories must agree to restrict disclosure of the designated documents to personnel with a legitimate "need to know" and commit to destroying all materials upon the earlier of project completion or the contract end date. The form requires completion of blanks identifying the specific document titles, project name, contract end date, and authorized representative information including printed name, signature, title, phone number, and company address.
The related procurement opportunity is an Invitation for Bid (IFB-26-0112) issued by the City of Phoenix Water Services Department for stainless steel bypass spools, stainless steel tailpieces, and ductile iron flanged fittings for water meter assemblies. The five-year contract is scheduled to commence January 1, 2026, with materials supplied on an as-needed basis across 132 line items in sizes ranging from 3 to 12 inches in diameter with quantities varying from 4 to 81 units. All materials must comply with ANSI/AWWA C110/A21.10 standards with a minimum 250 psi working pressure rating. A non-mandatory pre-offer conference is scheduled for October 29, 2025, with written inquiries due November 5, 2025, and sealed offers due November 12, 2025, at 2:00 p.m. Contractors must have a minimum five-year operational history, submit a Small Business Participation Plan within 30 days of award, maintain Commercial General Liability insurance with a $2,000,000 General Aggregate limit and $1,000,000 Each Occurrence limit, and comply with DBE participation requirements. Pricing will remain firm and fixed for 180 calendar days, with payment processed within 30 to 45 days after invoice receipt. Contract award will be made to the lowest responsive and responsible offeror.
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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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