Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Solicitation number
- RFQu-26-0091
- 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, applicable to a real estate services contract opportunity in Arizona. The form serves as a binding acknowledgement by contractors that documents designated for the Acquisition, Relocation and Related Real Estate Services contract contain Sensitive Security Information governed by 49 C.F.R. Parts 15 and 1520. Signatories agree that such information may only be disclosed to persons with a demonstrated "need to know" and must be destroyed upon the earlier of project completion or the contract end date specified by the City.
The form requires authorized company representatives to formally acknowledge receipt of and compliance obligations related to sensitive security materials. Unauthorized disclosure of the controlled information may result in civil penalties or other legal action. For U.S. government agencies, public disclosure restrictions are further governed by 5 U.S.C. 552 in addition to the Code of Federal Regulations. The acknowledgement must be completed with the company name, authorized representative's printed name and signature, title, phone number, and full address before contractors proceed with access to sensitive project documentation.
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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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