Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- HVAC Filter Maintenance and Repair
- Solicitation number
- 27-FMD-007
- 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 the HVAC Filter Maintenance and Repair contract opportunity. The form serves as a template requiring authorized company representatives to acknowledge receipt and understanding of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The City of Phoenix is soliciting sealed offers for full-service air filter maintenance and supply services, including all necessary labor, tools, materials, and supplies for replacing filters and performing HVAC maintenance at various City facilities. The contract term is three years commencing on or about September 1, 2026, with two option years available. The agreement will be awarded by City Council and becomes effective upon signature and recording by the City Clerk's department, in accordance with Phoenix City Code requirements.
Signatories to the acknowledgement form must agree to destroy all documents containing Sensitive Security Information upon the earlier of their company's completion of review and use or by the contract end date, in compliance with applicable federal regulations. The form requires completion of specific fields including document titles, project name, contract end date, company name, authorized representative information, and contact details. Unauthorized release of the Sensitive Security Information contained in project documents may result in civil penalties or other legal action. For technical support related to the City's Procurement Portal, offerors may contact procurement-support@opengov.com, while other solicitation questions should be directed to the listed procurement officer.
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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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