Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Event Equipment Rental Services
- Solicitation number
- PKS-IFB-26-0175
- 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 controlled security documentation related to federal aviation security regulations under 49 C.F.R. Parts 15 and 1520. The form requires authorized company representatives to acknowledge receipt of sensitive security information and commit to destroying such documents upon completion of contract work or by a specified contract end date. The acknowledgement must be signed by an authorized representative and include the company name, representative's printed name and signature, title, phone number, and complete address.
The form serves as a compliance mechanism for the City of Phoenix to ensure that contractors and bidders handling sensitive security information maintain strict confidentiality and proper document management protocols. By signing this acknowledgement, company representatives agree to restrict disclosure of the documents to persons with a demonstrated need to know and understand that unauthorized release may result in civil penalties or other legal action. This form is a standard requirement for contractors bidding on projects involving airport security or aviation-related services where sensitive security information must be protected under federal 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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