Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Financial Advisory Services
- Solicitation number
- RFQu-26-0189
- 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 conjunction with a financial advisory services contract. The form serves as a template 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 financial advisory services under a five-year contract with a commencement date on or about October 1, 2026. The contract term will be established upon City Council award and signature by the City Clerk's department, in accordance with Phoenix City Code requirements. The agreement will terminate upon the earliest occurrence of reaching the end of the contract term, including any exercised extensions, or upon termination pursuant to agreement provisions.
Authorized representatives from bidding companies must acknowledge receipt of sensitive security documents and agree to their restricted use and proper destruction in compliance with applicable federal regulations. Disclosure of the controlled information is limited to individuals with a demonstrated "need to know" as defined in the cited regulations, with unauthorized release potentially resulting in civil penalties or other legal action. Company representatives executing the form must provide their name, title, signature, phone number, and complete address. The form requires completion of specific document titles and project names, as well as the contract end date by which all documents must be destroyed or returned.
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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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