Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Theatre Historical Restoration
- Solicitation number
- RFQ-25-0746
- 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 a theatre historical restoration contract. The form serves as a template for bidders and contractors to acknowledge receipt and understanding of security protocols governing sensitive materials related to the five-year theatre historical restoration contract commencing January 1, 2026. The document establishes the legal framework for handling controlled information under federal regulations (49 C.F.R. Parts 15 and 1520) and requires authorized company representatives to sign and date the form, confirming their agreement to safeguard the specified documents and destroy them upon completion of use or at the contract end date, whichever occurs first.
The acknowledgement form enforces strict confidentiality requirements applicable to persons with a demonstrated "need to know" regarding the sensitive security information contained in project-related documents. Unauthorized disclosure may result in civil penalties or other legal action. The form requires standard identification information including the company name, authorized representative's printed name and signature, title, phone number, and complete address. This acknowledgement must be completed prior to the contractor's access to sensitive project documentation and represents a binding commitment to comply with federal security regulations and the City of Phoenix's information protection protocols.
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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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