Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Solicitation number
- IFB-26-0213
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department related to a five-year contract for GfG multi-gas monitors, repair and replacement parts, accessories, and services commencing on or about May 1, 2026. The form serves as a template document to be completed by authorized representatives of companies receiving access to sensitive security information controlled under 49 C.F.R. Parts 15 and 1520. The contract opportunity is being solicited through the City's Procurement Portal, with sealed offers invited in accordance with specifications and provisions outlined in the solicitation documents. The agreement will commence upon the later of May 1, 2026, or upon City Council award and execution by the City Clerk's department, as required by Phoenix City Code, and will terminate upon the earliest occurrence of reaching the end of the contract term (including any extensions) or termination pursuant to agreement provisions.
Prospective offerors and their authorized representatives must acknowledge and agree to the restrictions governing sensitive security information, confirming they understand that unauthorized release may result in civil penalties or other action and that they will destroy all controlled documents upon the earlier of completion of their need to review and use the materials or the contract end date. The form requires completion of the authorized representative's name, signature, title, phone number, and company address, and references applicable federal regulations governing security information disclosure for U.S. government agencies under 5 U.S.C. 552 and the Code of Federal Regulations. Technical support for the procurement portal is available through the platform's support function or via email to procurement-support@opengov.com, with other solicitation inquiries directed to the listed procurement officer.
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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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