Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Aquatic Rescue, Training Supplies and Equipment
- Solicitation number
- PKS-IFB-25-0743
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This document is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department. The form requires authorized representatives to recognize and agree to strict handling protocols for confidential documents related to an unspecified project involving sensitive security information controlled under federal regulations 49 C.F.R. Parts 15 and 1520.
The form mandates that recipients of sensitive documents can only disclose information to persons with a requisite "need to know" and must destroy the documents upon project completion or by the contract end date. Signatories must provide their company name, printed name, signature, title, contact information, and address, acknowledging potential civil penalties for unauthorized release of the documents. The form emphasizes compliance with federal guidelines for information protection and controlled document management.
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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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