Sensitive_Security_Information_Acknowledgement_Form.docx

This is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department for use in conjunction with a state and local contract opportunity. The form is designed to control disclosure of documents containing sensitive security information governed by 49 C.F.R. Parts 15 and 1520. The acknowledgement applies to specified documents related to the Employee Assistance Program contract, including elder care, traumatic event counseling, and substance abuse professional services. The five-year contract is scheduled to commence on or about April 1, 2027, with the effective date being upon City Council award and signature and recording by the City Clerk's department, whichever is later. The contract will terminate upon the earliest occurrence of reaching the end of the term including any extensions exercised or termination pursuant to agreement provisions.

All individuals and authorized representatives who receive access to these sensitive security documents must acknowledge and agree to the restrictions on disclosure and use. Signatories commit to destroying the documents in compliance with 49 C.F.R. Parts 15 and 1520 upon the earlier of their company's completion of its need to review and use the documents or no later than the contract end date. Unauthorized release of the sensitive security information may result in civil penalties 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. The form requires completion of company name, authorized representative printed name and signature, title, phone number, and address.