Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Membrane Diffusers State and local contract opportunity
Solicitation number
IFB-26-0382
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 conjunction with a membrane diffusers procurement. The form pertains to documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520, which restrict disclosure to authorized personnel with a demonstrated need to know. The City of Phoenix invites sealed offers for this procurement, with an effective date upon final signature and recording by the City Clerk's department. The agreement commencement date is on or around September 23, 2026, with a five-year term and no options to extend. The agreement will terminate upon the earliest occurrence of reaching the end of the term or pursuant to termination provisions within the agreement itself. Submissions are available through the City's Procurement Portal, with technical support available via the portal's support function or email to procurement-support@opengov.com.

Authorized representatives who receive documents containing Sensitive Security Information must acknowledge their understanding of the disclosure restrictions and agree to destroy the materials upon the earlier of the company's completion of its need to review or use the documents or no later than the current contract end date, in compliance with applicable federal regulations. Unauthorized release of this information may result in civil penalties or other legal action. The acknowledgement form requires signature from a company's authorized representative and includes fields for company name, representative name and title, phone number, and mailing address.

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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

File details come from the government source that posted it. Updated .