Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Solicitation number
- RFP-EED-26-0244
- 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 connection with an unspecified project. The form template is designed to ensure that individuals and companies receiving documents containing Sensitive Security Information (SSI) controlled under 49 C.F.R. Parts 15 and 1520 understand their obligations regarding disclosure restrictions and document handling. The form requires authorized representatives to acknowledge receipt of specified documents, confirm their understanding that only persons with a demonstrated need-to-know may access the materials, and agree to destroy the documents upon the earlier of completion of their use or a specified contract end date. The document includes blank fields for completion with the document titles, project name, contract end date, company name, authorized representative information, title, contact details, and address.
The form serves as a compliance mechanism for the City of Phoenix and establishes a binding acknowledgement by contractors and their companies that they will comply with federal security information regulations and face potential civil penalties for unauthorized disclosure. While the template references use in connection with the Head Start Birth to Five Program Classroom Behavior and Educational Coach Services procurement, the form itself contains no specific contractual terms, pricing information, performance requirements, or project details beyond the security information control framework. Signatories are required to preserve the confidentiality and secure destruction protocols mandated by federal transportation security regulations applicable to airport operations and related sensitive facility information.
View the file
Other files
Show all 27
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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
File details come from the government source that posted it. Updated .