Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
FMLA and PPL Administration Service
Solicitation number
RFP PS-26-0173
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 connection with a state and local contract opportunity. The form is designed to protect documents containing sensitive security information controlled under 49 C.F.R. Parts 15 and 1520 and restricts disclosure to personnel with a documented need to know. The form requires authorized representatives of bidding companies to acknowledge their understanding of these restrictions and commit to destroying the documents upon the earlier of project completion or a specified contract end date, in compliance with applicable federal regulations.

The form serves as a protective mechanism for the FMLA and PPL Administration Services contract opportunity issued by the City of Phoenix Finance Department's Central Procurement Division. While the form itself contains only template language requiring completion with specific document titles and project names, it establishes that certain solicitation materials or contract-related documents associated with the five-year FMLA and PPL administration contract (commencing January 1, 2027) contain sensitive security information that must be handled with heightened confidentiality measures. Unauthorized disclosure of such information may result in civil penalties or other enforcement actions under federal law, underscoring the importance of this acknowledgement requirement as part of the bidding and contracting process.

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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

______
TITLEPHONE NUMBER

ADDRESS CITY, STATE AND ZIP CODE

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