Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Comprehensive Community Needs Assessment State and local contract opportunity
Solicitation number
RFP-CSID-26-0198
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department, required for individuals and organizations accessing documents containing security-sensitive information regulated under 49 C.F.R. Parts 15 and 1520. The form establishes that specified documents related to an unnamed project contain controlled information that may only be disclosed to personnel with an established "need to know." All recipients must sign the acknowledgement confirming their understanding of federal restrictions and their obligation to destroy the documents upon completion of their review or use, or by a specified contract end date, whichever occurs first. The form includes standard fields for the company name, authorized representative's printed name and signature, title, phone number, and complete mailing address.

The acknowledgement form functions as a compliance mechanism ensuring that contractors and bidders respect federal aviation security protocols prior to accessing sensitive project materials. Unauthorized disclosure of information covered under these federal regulations may result in civil penalties or other enforcement action. For U.S. government agencies, disclosure is additionally governed by the Freedom of Information Act (5 U.S.C. 552). This form must be completed and signed by an authorized company representative before sensitive project documentation can be provided, serving as a prerequisite to contract participation for the City of Phoenix Aviation Department projects.

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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 .