Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Wireless Radio Maintenance
Solicitation number
IFB-26-0289
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 Wireless Radio Maintenance contract opportunity for the Water Services Department. The form establishes compliance requirements for handling documents containing Sensitive Security Information as defined under 49 C.F.R. Parts 15 and 1520. The City of Phoenix is soliciting sealed offers for wireless radio maintenance, repair, and support services for Water Services Department infrastructure under a five-year contract with a commencement date of approximately July 1, 2026. The contract will become effective upon award by City Council and signature and recording by the City Clerk's department, in accordance with Phoenix City Code provisions.

All recipients of documents marked as containing Sensitive Security Information must acknowledge understanding that such materials may only be disclosed to persons with a documented "need to know" as defined in federal regulations. Unauthorized release of this information may result in civil penalties or other legal action. Signatories agree to destroy all marked documents upon the earlier of either completion of their need to review and use the materials or by the contract's end date. The acknowledgement form requires completion of specific fields including document titles, project name, contract end date, company name, authorized representative information, and contact details. Offerors should direct technical questions regarding the City's Procurement Portal to the listed support channels and address other solicitation-related inquiries to the designated procurement officer.

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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

______
TITLEPHONE NUMBER

ADDRESS CITY, STATE AND ZIP CODE

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