Sensitive_Security_Information_Acknowledgement_Form.docx

This is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department in connection with an Occupational Medicine Staffing Services and Electronic Health Records Management contract opportunity. The form establishes protocol for handling documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The City of Phoenix seeks sealed offers for occupational medicine staffing services and electronic health records management for a three-year initial term commencing on or about October 1, 2026, with two one-year extension options available. The contract will be awarded by City Council, with the effective date triggered upon award, signature, and recording by the City Clerk's department, or whichever occurs later. Offerors must access the solicitation through the City's Procurement Portal and may contact the designated procurement officer for solicitation-related questions or procurement-support@opengov.com for technical portal support.

The form requires authorized representatives from bidding companies to acknowledge receipt of sensitive security documents, certify their understanding of disclosure restrictions, and commit to destruction of the materials upon completion of their need to review or use them or by the contract end date, whichever is earlier. Unauthorized release of the controlled information may result in civil penalties or other legal action. The acknowledgement must be signed by an authorized company representative and include the company name, representative's printed name, title, phone number, and complete business address. All persons with access to the sensitive documents must have the requisite "need to know" as defined in applicable federal regulations, and public disclosure is further governed by 5 U.S.C. 552.