Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Solicitation number
- IFB-26-0008
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This document is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department. The form is designed to protect sensitive security information controlled under federal regulations 49 C.F.R. Parts 15 and 1520, with specific provisions for document handling, disclosure, and destruction. Authorized representatives of companies must agree to strictly manage documents containing sensitive security information, ensuring they are only shared with individuals who have a requisite "need to know" and are destroyed by the specified contract end date.
The acknowledgement form requires detailed company information, including the authorized representative's name, signature, title, contact information, and complete address. Signatories explicitly acknowledge the potential for civil penalties or other actions for unauthorized release of the protected documents. The form serves as a legal agreement to maintain the confidentiality of sensitive security information related to an unspecified aviation project, with strict compliance requirements under federal regulations governing information disclosure and protection.
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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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