Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Hydrofluorosilicic Acid 24. 5%
- Solicitation number
- IFB-26-0165
- 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 in conjunction with a state and local contract opportunity for hydrofluorosilicic acid 24.5% to be procured by the City of Phoenix, Arizona. The form serves as a compliance document requiring authorized representatives from bidding companies to acknowledge and agree to the restrictions governing the handling of sensitive security information contained in project documents. The hydrofluorosilicic acid contract is a five-year agreement with an anticipated commencement date of April 1, 2026, contingent upon City Council award and signature and recording by the City Clerk's department as required by Phoenix City Code. Solicitations are submitted through the City's Procurement Portal, with technical support available through the platform or via procurement-support@opengov.com. The contract will terminate upon the earliest occurrence of reaching the end of the term including any exercises of extension rights or upon termination pursuant to the agreement's provisions.
Signatories to the Sensitive Security Information Acknowledgement Form must acknowledge that all documents containing sensitive security information are controlled under 49 C.F.R. Parts 15 and 1520 and may only be disclosed to persons with requisite "need to know" as defined in those regulations. Unauthorized release of such information may result in civil penalties or other action, with public disclosure by U.S. government agencies governed by 5 U.S.C. 552 and 49 C.F.R. Parts 15 and 1520. Authorized representatives agree to destroy all designated documents in compliance with applicable federal regulations upon the earlier of the company's completion of its need to review and use the documents or no later than the current contract end date.
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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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