Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Employee Health Clinic Services
- Solicitation number
- RFP PS-26-0095
- 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 the Employee Health Clinic Services contract opportunity (Request for Proposal PS 26-0095). The form establishes protocols for handling documents classified as Sensitive Security Information under 49 C.F.R. Parts 15 and 1520. The City of Phoenix Finance Central Procurement is soliciting proposals for employee health clinic services to serve approximately 32,000 eligible city employees and dependents enrolled in three self-funded medical insurance plans. The contractor must establish and operate a near-site health clinic providing same-day or next-day medical appointments, primary care, urgent care, limited pharmaceutical services, preventive health and wellness services, and optional behavioral health services. The proposed clinic location should be within two city blocks of 1st Avenue and Washington Street, operating Monday through Friday from 7:00 a.m. to 6:00 p.m. Arizona Time. A non-mandatory pre-offer conference is scheduled for February 3, 2026, written inquiries must be submitted by February 6, 2026, and proposals are due February 23, 2026, at 2:00 p.m. The contract term is five years, commencing January 1, 2027, with implementation no later than June 2026.
The contractor bears all costs for establishing and operating the clinic, including leasing or owning real property, constructing or leasing the building, furnishing equipment and fixtures, and funding future renovations. Proposals will be evaluated using weighted criteria: Method of Approach (42.5 percent), Qualifications and Experience (30 percent), and Pricing Proposal (27.5 percent). Qualified offerors must demonstrate a minimum of five consecutive years of experience providing employee health clinic services for comparable organizations. Pricing must be firm and fixed for the entire five-year term through December 31, 2031. The contractor must obtain a performance bond equal to 10 percent of the total contract amount within 14 days of award notification and maintain comprehensive insurance coverage including Commercial General Liability ($2,000,000 aggregate), Professional Liability ($1,000,000 per claim), and Network Security and Privacy Liability ($1,000,000 per claim). All offerors must execute Federal Transit Administration certifications and a Business Associate Agreement establishing HIPAA compliance obligations. Contractors must comply with Disadvantaged Business Enterprise requirements under 49 CFR Part 26, with initial plans due 30 calendar days after contract award and annual updates thereafter.
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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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