Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Solicitation number
- RFQu-26-0091
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department designed for use with contract opportunities involving controlled security information. The form establishes compliance requirements for handling documents containing Sensitive Security Information (SSI) as defined under 49 C.F.R. Parts 15 and 1520. Signatories must acknowledge restrictions on disclosure to authorized personnel with demonstrated "need to know" and commit to document destruction upon completion of the review and use period or by the contract end date, whichever occurs earlier. The form requires authorized representatives to provide company name, printed name, signature, title, phone number, and complete address information.
The form applies to the City of Phoenix Finance Department's Request for Qualifications (RFQu-26-0091) for acquisition, relocation, and related real estate services commencing April 1, 2026. Given the Aviation Department's involvement and references to Federal Aviation Administration (FAA) compliance requirements in the related procurement, the SSI designation likely pertains to airport security, infrastructure, or operational information disclosed during the contractor selection and contract execution process. All prospective bidders and authorized representatives accessing procurement documents containing SSI must execute this acknowledgement to comply with federal security information handling regulations and protect against civil penalties or enforcement actions for unauthorized disclosure.
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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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