Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Exclusive Event Utilities
- Solicitation number
- RCS-PCC-26-0218
- 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 the Exclusive Event Utilities contract opportunity. The form establishes requirements for handling documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The five-year Exclusive Event Utilities contract is set to commence on or about October 1, 2026, with the effective date contingent upon City Council award and execution by the City Clerk's department in accordance with Phoenix City Code requirements. Offers are submitted through the City's Procurement Portal, with technical support available through the portal support function or via procurement-support@opengov.com. The contract will terminate upon the earliest occurrence of the end of the initial term plus any exercised extensions or upon termination per the agreement's provisions.
All parties receiving the controlled documents must acknowledge they have the requisite "need to know" as defined in the applicable federal regulations and agree to comply with disclosure restrictions, which carry potential civil penalties for unauthorized release. Recipients must certify their understanding of these requirements through execution of this acknowledgement form, providing company name, authorized representative information, title, contact details, and address. Upon completion of the need to review and use the documents or no later than the contract end date, whichever is earlier, all recipients must destroy the documents in full compliance with federal regulations governing sensitive security information.
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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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