Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Electric Actuators
- Solicitation number
- IFB-26-0274
- 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 a state and local contract opportunity. The form pertains to a five-year electric actuators contract commencing on or about May 1, 2026, and requires authorized representatives from bidding companies to acknowledge receipt of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. Signatories must certify that they understand the restricted disclosure requirements and agree to destroy the specified documents upon the earlier of contract completion or the contract end date. The form serves as a compliance mechanism to ensure that only individuals with a documented "need to know" access security-sensitive materials related to the City of Phoenix Aviation Department procurement.
The acknowledgement form establishes legal obligations under federal aviation security regulations and reinforces that unauthorized release of the controlled information may result in civil penalties or other enforcement actions. Signatory information must include the company name, authorized representative's printed name, signature, title, phone number, and complete address. For U.S. government agencies involved in the procurement process, public disclosure of the sensitive documents is governed by the Freedom of Information Act (5 U.S.C. 552) and federal aviation security regulations. This form is a standard requirement for all parties receiving detailed technical specifications, security protocols, or other sensitive materials related to the City's Aviation Department operations and must be completed prior to accessing or reviewing restricted procurement 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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