Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Hydrofluorosilicic Acid 24. 5%
- Solicitation number
- IFB-26-0165
- 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 for use in connection with a contract 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. The form mandates that signatory parties understand the restricted disclosure requirements and agree to destroy specified documents upon the earlier of project completion or a designated contract end date. Authorized representatives must provide their printed name, signature, title, phone number, and complete address to execute the acknowledgement.
This acknowledgement form is associated with the City of Phoenix Water Services Department's Invitation for Bid (IFB-26-0165) for hydrofluorosilicic acid 24.5%, a water treatment chemical. The five-year contract commences April 1, 2026, with an estimated annual procurement of 1,500,000 dry pounds. A non-mandatory pre-offer conference is scheduled for January 15, 2026, at 1:00 pm via webex, with written inquiries due by January 22, 2026, at 2:00 pm, and sealed offers due February 2, 2026, at 2:00 pm. Offerors must maintain NSF certification, comply with AWWA B703-84 specifications, possess minimum five years of operational experience, and submit pricing on a per-unit basis calculated as cost per dry pound F.O.B. destination. Award will be made to the lowest responsive and responsible offeror, with offers remaining firm for 180 calendar days from solicitation opening. The contract includes potential price adjustments after year one with 60 days' notice, comprehensive insurance requirements including general liability and pollution liability coverage, and contractor responsibility for all delivery logistics and hazardous materials compliance.
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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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