Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Theatre Historical Restoration
- Solicitation number
- RFQ-25-0746
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This document is a Sensitive Security Information Acknowledgement Form for 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), requiring signatories to maintain strict confidentiality of specific documents related to an unspecified project. The form mandates that recipients can only access the documents with a legitimate "need to know" and must destroy them by the contract's end date.
The acknowledgement form serves as a legal agreement where the company representative commits to protecting sensitive information, with potential civil penalties for unauthorized disclosure. Signatories must provide their company name, authorized representative's printed name, signature, title, contact information, and full address. The document emphasizes compliance with federal regulations regarding information security, particularly for government agencies and contractors dealing with sensitive aviation-related documentation.
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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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