Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Cancer Screening Services State and local contract opportunity
Solicitation number
RFP PS-26-0132
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 related to a Cancer Screening Services contract opportunity. The form establishes protocols for handling documents containing Sensitive Security Information (SSI) as defined under 49 C.F.R. Parts 15 and 1520. The City of Phoenix is soliciting sealed offers for cancer screening services under a five-year contract with an anticipated commencement date of July 1, 2027. The contract becomes effective upon award by City Council and subsequent signature and recording by the City Clerk's department, in accordance with Phoenix City Code requirements. The solicitation is available through the City's Procurement Portal, with technical support available through the platform's support feature or via procurement-support@opengov.com. The contract will terminate upon the earliest occurrence of reaching the end of the term including any exercised extensions or upon termination pursuant to contract provisions.

Offerors accessing SSI documents must acknowledge their understanding of the handling requirements and agree to destroy all documents upon the earlier of either the completion of their need to review and use the materials or by the contract end date. The acknowledgement form requires an authorized representative of the company to provide their name, title, signature, phone number, and complete address. This form serves as a critical compliance document for any bidder seeking to participate in the cancer screening services procurement and must be completed prior to accessing sensitive aviation security-related documentation.

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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 .