Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Sodium Hypochlorite
Solicitation number
IFB-26-0155
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 state and local contract opportunity. The form serves as a binding acknowledgment that recipients of sensitive security information controlled under 49 C.F.R. Parts 15 and 1520 understand the restrictions on disclosure and use of such information. The form requires authorized company representatives to acknowledge receipt of specified documents, confirm their understanding that only persons with requisite "need to know" may access the materials, and commit to destroying the documents upon the earlier of either the company's completion of its need to review and use the materials or the contract end date specified by the City.

The acknowledgement form is a compliance document associated with the City of Phoenix's sealed bid solicitation for sodium hypochlorite, a five-year supply contract commencing on or about April 1, 2026. Offerors must sign and return the form to demonstrate their commitment to protecting sensitive security information in accordance with federal regulations. The form requires completion of blanks indicating the specific document titles, project name, and contract end date. Failure to comply with the security information restrictions outlined in this acknowledgement may result in civil penalties or other legal action under federal law. This form is a prerequisite step in the procurement process and reflects the City of Phoenix's requirement that all parties handling sensitive materials maintain strict confidentiality standards throughout the contract term.

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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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