Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
State Fair Towing Services
Solicitation number
IFB-26-0294
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This is a Sensitive Security Information Acknowledgement Form for the City of Phoenix Aviation Department related to a State Fair Towing Services contract opportunity. The form is designed to control and restrict access to sensitive security information governed by 49 C.F.R. Parts 15 and 1520. Signatories acknowledge that designated documents containing sensitive security information may only be disclosed to individuals with requisite "need to know" and agree to destroy the documents upon the earlier of completing their need to review and use them or by the contract end date of July 1, 2031. The form requires completion of the authorized representative's name, title, signature, phone number, and company address.

The City of Phoenix seeks sealed offers for State Fair Towing Services through its Procurement Portal, with an effective date upon final signature and recording by the City Clerk and a commencement date of July 1, 2026, or the effective date, whichever is later. The contract term is five years with no options to extend and will terminate upon the earliest of reaching the end of the term or pursuant to termination provisions within the agreement. Unauthorized release of sensitive security information carries potential civil penalties and other legal consequences. Technical support for portal access is available through the procurement support portal or at procurement-support@opengov.com, with additional solicitation inquiries directed to the listed 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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