Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Horizontal Lifeline & Vertical Fall Protection Systems Inspections and Repairs
Solicitation number
IFB-26-0008
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 horizontal lifeline and vertical fall protection systems inspections and repairs contract. The form serves as a compliance document requiring authorized representatives of bidding companies to acknowledge and agree to the handling restrictions of sensitive security information governed by 49 C.F.R. Parts 15 and 1520. The five-year contract is scheduled to commence on or about October 1, 2025, with the effective date occurring upon award by City Council and subsequent signature and recording by the City Clerk's department as required by Phoenix City Code. Offerors must complete and submit this acknowledgement form, certifying that they understand that the documents contain controlled security information that may only be disclosed to personnel with requisite "need to know" authorization, and that unauthorized release may result in civil penalties or other legal action.

The acknowledgement form requires authorized representatives to commit to the destruction of all sensitive security information documents upon the earlier of either the company's completion of its need to review and use the documents or the contract end date. Signatories must provide complete identification information including company name, authorized representative name and signature, title, phone number, and full address. This form is a prerequisite compliance document and does not contain pricing, funding, or specific performance requirements; rather, it establishes the legal framework for protecting sensitive aviation security information throughout the contract period. Offerors should direct technical support questions to the OpenGov e-Procurement Portal support or procurement-support@opengov.com, and other solicitation-related inquiries to the designated procurement officer.

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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

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