Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Lifeguard Uniforms
- Solicitation number
- PKS-IFB-26-0193
- 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 in connection with a separate procurement opportunity. The form serves as a template requiring authorized representatives from bidding companies to acknowledge receipt of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520 and to certify their understanding of restrictions on disclosure and use. Signatories agree to destroy specified documents upon the earlier of project completion or the contract end date, with unauthorized release subject to civil penalties or other legal action. The form requires signature from an authorized company representative along with printed name, title, phone number, and complete address.
This acknowledgement form is administratively associated with the City of Phoenix Parks and Recreation Department's Invitation for Bid for Lifeguard Uniforms, a five-year contract commencing April 1, 2026. The solicitation covers 43 line items of branded swimwear and cover garments from manufacturers including Speedo and Watermen, with delivery required within 30 days to Parks and Recreation warehouses on an FOB destination basis. Key deadlines include a pre-offer conference on February 2, 2026, written inquiries due February 4, 2026, and sealed offers due February 13, 2026, submitted through the City's Procurement Portal. Offerors must demonstrate a minimum five-year operating history and relevant experience; pricing must be submitted on a per-unit, firm and fixed basis for the initial year with City-approved annual adjustments thereafter. The contract includes mandatory compliance with Title VI, the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, DBE requirements under 49 CFR Part 26, E-Verify employment verification, and standard insurance and licensing requirements.
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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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