Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Lifeguard Uniforms
- Solicitation number
- PKS-IFB-26-0193
- 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 separate procurement opportunity. The form template requires signatories to acknowledge receipt of security-controlled documents related to an unspecified project and to comply with federal regulations governing sensitive security information under 49 C.F.R. Parts 15 and 1520. Signatories must commit to destroying the documents upon the earlier of project completion or a specified contract end date. The form requires completion of placeholder fields including document titles, project name, contract end date, and authorized representative information (name, signature, title, phone number, and company address).
The Sensitive Security Information Acknowledgement Form is a compliance document unrelated to the Lifeguard Uniforms procurement opportunity. While both documents originate from the City of Phoenix, the acknowledgement form is a standalone template with no connection to the lifeguard uniform solicitation, which concerns procurement of specified swimwear and cover garments with no security-related restrictions. Organizations responding to the lifeguard uniform opportunity would not be required to execute this security acknowledgement form unless their involvement extends to other City of Phoenix Aviation Department projects involving controlled security information.
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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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