Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Critical Incident Psychological Services
- Solicitation number
- RFQu-26-0231
- 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 Critical Incident Psychological Services contract. The form is designed to control access to documents containing Sensitive Security Information as regulated under 49 C.F.R. Parts 15 and 1520. The City of Phoenix is soliciting sealed offers for critical incident psychological services under a five-year contract with a commencement date on or about November 1, 2026. The contract becomes effective upon award by City Council, conditioned upon signature and recording by the City Clerk's department, and will terminate at the earliest occurrence of the contract end date or any extensions exercised, or upon termination pursuant to the agreement's provisions.
The acknowledgement form requires authorized representatives from responding companies to sign and agree to protect the sensitive documents and destroy them upon the earlier of either completion of their need to review and use the documents or the contract end date. All disclosure of the controlled documents is limited to persons with requisite "need to know" status as defined in the applicable federal regulations, with unauthorized release subject to civil penalties or other legal action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and the referenced Code of Federal Regulations sections. The City's Procurement Portal serves as the submission mechanism for this solicitation, with technical support available through the portal or via procurement-support@opengov.com.
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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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