Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- SHOPLIFTING/THEFT DIVERSION PROGRAM
- Solicitation number
- RFP PS-26-0265
- 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 related to a Shoplifting/Theft Diversion Program contract opportunity in Arizona. The form serves as a required acknowledgment that recipients of specified documents understand those materials contain Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520 and may only be disclosed to persons with a legitimate "need to know." The City of Phoenix is soliciting sealed offers for a Shoplifting/Theft Diversion Program with an initial three-year term and two optional one-year renewal periods, with the contract commencing on or about July 1, 2026. The solicitation is available through the City's Procurement Portal, and interested offerors should contact the designated procurement officer for questions regarding the opportunity.
Authorized representatives of bidding companies must sign the acknowledgement form, agreeing on behalf of their organization to comply with federal security information regulations and to destroy all specified documents upon the earlier of either completion of their need to review and use the materials or the contract end date. The form requires completion of template fields including document titles, project name, and contract end date. Unauthorized release of the sensitive security information contained in the project documents may result in civil penalties or other legal action under applicable federal statutes and regulations.
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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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