Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Silica Dioxide
Solicitation number
IFB-26-0161
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This is a Sensitive Security Information Acknowledgement Form prepared by the City of Phoenix Aviation Department for use in connection with a silica dioxide procurement contract. The form establishes protocols for handling classified security documentation related to the five-year silica dioxide contract commencing on or about April 1, 2026. The contract will be awarded by City Council, with the effective date contingent upon signature and recording by the City Clerk's department in accordance with Phoenix City Code requirements. The agreement will terminate upon the earliest occurrence of reaching the end of the contract term, including any extensions exercised, or upon termination pursuant to the agreement's provisions.

The acknowledgement form requires authorized representatives from bidding companies to certify their understanding that project documents contain Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520, with disclosure limited to persons with requisite "need to know" as defined in federal regulations. Signatories must agree to destroy all provided documents in compliance with applicable federal standards upon the earlier of their company's completion of document review and use or the contract end date. Unauthorized release of such information may result in civil penalties or other legal action. The form requires completion of company name, authorized representative information, title, contact details, and address prior to submission. Technical support for the City's Procurement Portal is available through the support feature or at procurement-support@opengov.com.

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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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