Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Portland Cement (Bulk)
- Solicitation number
- IFB-26-0033A
- 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 conjunction with a Portland Cement (Bulk) procurement contract for the Street Transportation Department. The City of Phoenix is soliciting sealed bids for a five-year contract to supply approximately 300 tons annually of ASTM C-150, Type II Low Alkali Portland cement, with delivery to the Street Transportation Preventive Maintenance facility between 7:00 am and 2:00 pm, Monday through Friday, excluding city holidays. The solicitation (IFB-26-0033A) includes a non-mandatory pre-offer conference on November 4, 2025, with written inquiries due by November 19, 2025, and final offer submissions due November 24, 2025, at 2:00 pm local time. The contract is scheduled to commence on July 1, 2026, or upon City Council award and City Clerk signature and recording, and will terminate upon completion of the five-year term or earlier termination per contract provisions.
Pricing will be firm and fixed for the initial two years, with potential annual price adjustments thereafter subject to written documentation and Chief Procurement Officer approval. The procurement emphasizes Disadvantaged Business Enterprise (DBE) and small business participation, requiring contractors to submit annual participation plans, use good faith efforts to identify DBE-certified suppliers, maintain detailed documentation of interactions, and report monthly through the City's Certification and Compliance System. Contractors must provide Safety Data Sheets meeting ASTM and Maricopa Association of Governments specifications and maintain sufficient local inventory to support daily city requirements. The Sensitive Security Information Acknowledgement Form requires authorized company representatives to acknowledge receipt of controlled security documents and commit to destroying such documents upon contract completion or the contract end date, in compliance with 49 C.F.R. Parts 15 and 1520.
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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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