Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Vending Machines, Maintenance, and Parts
Solicitation number
IFB-26-0247
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This is a Sensitive Security Information Acknowledgement Form prepared by the City of Phoenix Aviation Department for use in connection with a vending machines, maintenance, and parts contract. The form establishes protocols for handling documents containing Sensitive Security Information as controlled under 49 C.F.R. Parts 15 and 1520. The City of Phoenix is soliciting sealed offers for vending machines, maintenance, and parts under a five-year contract with an anticipated commencement date of May 20, 2026. The solicitation is being conducted through the City's Procurement Portal, and the effective date of the agreement will be upon award by City Council, conditioned upon signature and recording by the City Clerk's department, as required by Phoenix City Code. The contract will terminate upon the earliest occurrence of reaching the end of the term including any extensions exercised or termination pursuant to the provisions of the agreement.

Authorized representatives of companies submitting offers must acknowledge receipt of documents containing Sensitive Security Information and agree to comply with federal regulations governing disclosure restrictions. Signatories agree to limit disclosure to persons with a requisite "need to know" and commit to destroying the documents upon the earlier of the company's completion of its need to review and use the documents or no later than the current contract end date. Unauthorized release of Sensitive Security Information may result in civil penalties or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and the aforementioned Code of Federal Regulations provisions. The acknowledgement form requires completion of specific details including document titles, project name, and contract end date prior to execution by an authorized company representative.

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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

______
TITLEPHONE NUMBER

ADDRESS CITY, STATE AND ZIP CODE

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