Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Bypass Spools and Tailpieces
Solicitation number
IFB-26-0112
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 contract opportunity. The form serves as a template to acknowledge receipt and control of documents containing Sensitive Security Information (SSI) as regulated under 49 C.F.R. Parts 15 and 1520. The form requires authorized representatives of bidding companies to confirm their understanding of disclosure restrictions, acknowledge that only personnel with a documented "need to know" may access the specified documents, and agree to destroy all materials upon completion of their review or use or by the contract end date, whichever occurs first. The form includes signature lines for the company's authorized representative, printed name, title, phone number, and complete address.

The acknowledgement form represents a standard security compliance requirement applicable to the City of Phoenix Water Services Department's Invitation for Bid IFB-26-0112 for bypass spools and tailpieces. All bidders and their personnel who will access contract-related documents must execute this form as a condition of participation in the procurement process. Unauthorized disclosure of Sensitive Security Information carries potential civil penalties and other legal consequences under federal regulations. The form emphasizes that for U.S. government agencies, public disclosure is additionally governed by the Freedom of Information Act (5 U.S.C. 552) and applicable Department of Transportation security regulations, reinforcing the strict confidentiality requirements associated with this water infrastructure procurement.

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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

File details come from the government source that posted it. Updated .