Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Geosynthetic Materials
- Solicitation number
- IFB 26-SWDD-015
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
The document is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department. This form is associated with a geosynthetic materials procurement opportunity for the State Route 85 (SR85) Landfill cell design and construction project. The contract will have an initial three-year term with two potential option years, anticipated to commence on or about October 1, 2025. The solicitation is available through the City's Procurement Portal, with technical support provided via OpenGov e-Procurement Portal.
The acknowledgement form specifically requires signatories to recognize the sensitive nature of the documents, adhering to federal regulations under 49 C.F.R. Parts 15 and 1520 regarding information disclosure. Authorized representatives must agree to destroy documents upon project completion or contract end date. The procurement is for geosynthetic materials needed for landfill cell construction, with the contract to be awarded by City Council and contingent upon signature and recording by the City Clerk's department. The solicitation is specific to Arizona and involves the City of Phoenix's procurement processes for landfill infrastructure development.
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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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