Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Youth Crime Prevention Program
- Solicitation number
- HSD-RFP-26-0074
- 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 in conjunction with contract opportunities involving controlled security documentation. The form serves as a template that requires contractors and their authorized representatives to acknowledge receipt of documents containing Sensitive Security Information governed by 49 C.F.R. Parts 15 and 1520, which restrict disclosure to individuals with a demonstrated "need to know." Signatories agree to comply with federal regulations regarding the handling and destruction of such materials, committing to destroy documents upon the earlier of either the completion of their need to review and use the materials or by a specified contract end date. The form requires completion of blanks identifying the specific document titles, project name, and contract termination date before execution by an authorized company representative.
The acknowledgement form applies to the Youth Crime Prevention Program solicitation (HSD-RFP-26-0074) issued by the City of Phoenix Human Services Department for a three-year contract commencing January 1, 2026. While the contract itself carries a total annual value of $500,000 with two optional renewal years, this particular form relates to sensitive security information components within the procurement materials and is unrelated to the youth services program's core deliverables. The form functions as a compliance mechanism to ensure that all parties handling restricted aviation security documentation understand their legal obligations under federal transportation security regulations and agree to safeguard such information throughout the contract period and beyond.
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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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