Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Welding and Sheet Metal Fabrication Services
- Solicitation number
- IFB 26-FMD-034
- 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 the Welding and Sheet Metal Fabrication Services contract (IFB 26-FMD-034). The form notifies bidders and contractors that solicitation documents contain Sensitive Security Information governed by 49 C.F.R. Parts 15 and 1520, which restricts disclosure to individuals with an established need-to-know. Authorized company representatives must sign the acknowledgement to confirm understanding of these restrictions and agree to comply with federal regulations regarding the handling and destruction of sensitive materials. The form requires completion of contractor name, authorized representative information, signature, title, phone number, and address before document release.
The acknowledgement form serves as a compliance mechanism requiring contractors to certify their commitment to protecting sensitive security information related to airport operations at Phoenix Sky Harbor International Airport, Deer Valley Airport, and Goodyear Airport. Contractors must destroy all documents upon the earlier of project completion or the contract end date (to be filled in upon award). Unauthorized disclosure of sensitive security information may result in civil penalties or other legal action under federal aviation security regulations. This requirement is standard for airport-related procurement and must be executed by all bidders prior to receiving restricted solicitation materials.
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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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