Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Caustic Soda
- Solicitation number
- IFB-26-0163
- 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 connection with a caustic soda procurement contract. The form establishes protocols for handling documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The City of Phoenix is soliciting sealed offers for caustic soda under a five-year contract with an effective date on or about April 1, 2026, contingent upon City Council award and execution by the City Clerk's department in accordance with Phoenix City Code. The contract will terminate upon the earliest occurrence of contract end date, any exercised extensions, or termination pursuant to contract provisions. Solicitation submissions are to be made through the City's Procurement Portal, with technical support available through the portal's support function or via email at procurement-support@opengov.com.
Any authorized representative of an offeror receiving the Documents must sign and acknowledge receipt of this form, confirming their understanding of disclosure restrictions and their obligation to destroy the documents upon the earlier of the company's completion of its need to review and use the Documents or by the specified contract end date. Unauthorized release of the Sensitive Security Information may result in civil penalties or other legal action under federal law. The form requires completion of specific information including document titles, project names, contract end dates, company name, authorized representative details, and contact information prior to execution.
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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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