Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Vending Machines, Maintenance, and Parts
Solicitation number
IFB-26-0247
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 vending machines, maintenance, and parts procurement contract. The form addresses the handling of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The City of Phoenix solicited sealed offers for a five-year vending machines, maintenance, and parts contract with a commencement date of approximately May 20, 2026. The sealed bid deadline is March 10, 2026, with the contract becoming effective upon award by City Council and subsequent signature and recording by the City Clerk's department. The contract will terminate upon the earliest occurrence of the expiration of the five-year term, including any exercised extensions, or upon termination pursuant to the agreement's provisions.

The acknowledgement form requires authorized company representatives to sign and agree to comply with federal security regulations governing the disclosure and destruction of sensitive security information. Signatories must acknowledge receipt of specified documents and commit to destroying them upon the earlier of the company's completion of its need to review and use the documents or the contract end date, in accordance with applicable federal regulations. The form includes fields for company name, authorized representative information, title, phone number, and complete address. Unauthorized release of the sensitive security information may result in civil penalties or other legal action, with public disclosure governed by 5 U.S.C. 552 and the aforementioned federal regulations. Technical support for portal-related inquiries is available through the City's Procurement Portal, while other solicitation questions should be directed to the designated procurement officer.

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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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