Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Valves
- Solicitation number
- IFB-26-0134
- 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 Valves procurement contract. The form serves as a template through which authorized representatives of bidding companies acknowledge receipt of documents containing Sensitive Security Information (SSI) controlled under 49 C.F.R. Parts 15 and 1520. The five-year Valves contract for the City of Phoenix commences on or about June 1, 2026, with the effective date contingent upon City Council award and execution by the City Clerk's department, as required by Phoenix City Code. Offerors must submit sealed offers through the City's Procurement Portal, with technical support available through the portal's support function or via procurement-support@opengov.com.
The Sensitive Security Information Acknowledgement Form requires authorized company representatives to agree that the specified documents will only be disclosed to individuals with requisite "need to know" access and will be destroyed upon the earlier of the company's completion of its review and use or the contract end date, in compliance with applicable federal regulations. Unauthorized release of SSI may result in civil penalties or other enforcement action. The acknowledgement must be signed by an authorized representative and include the company name, representative's printed name, title, phone number, and complete address. The form emphasizes that for U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and applicable Code of Federal Regulations sections, reflecting the security-sensitive nature of information related to aviation facility operations.
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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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