Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Alco-Sensor Equipment, Parts and Supplies
- Solicitation number
- IFB-26-0123
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form for the City of Phoenix Aviation Department related to a five-year Alco-Sensor equipment, parts, and supplies contract commencing on or about November 1, 2026. The form requires authorized representatives from bidding companies to acknowledge receipt of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. All parties receiving these documents must certify they have the requisite "need to know" and agree to comply with federal regulations governing the handling and disclosure of security-sensitive materials. Signatories commit to destroying the specified documents upon the earlier of their company's completion of review and use or by the contract end date, in compliance with applicable regulations.
The form serves as a protective mechanism for the City of Phoenix Aviation Department to ensure that only authorized personnel with legitimate need-to-know access handle sensitive security information related to the solicitation. Unauthorized disclosure 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 signatory's printed name, title, phone number, and complete address. For U.S. government agencies involved in the procurement, public disclosure of sensitive materials is additionally governed by 5 U.S.C. 552 and the aforementioned C.F.R. regulations.
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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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