Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Pan - Tilt - Zoom (PTZ) Cameras
- Solicitation number
- IFB-26-0280
- 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 connection with a Pan-Tilt-Zoom (PTZ) cameras procurement project. The form serves as a required acknowledgement that recipients of specified documents understand those materials contain Sensitive Security Information governed by 49 C.F.R. Parts 15 and 1520 and may only be disclosed to individuals with a demonstrated "need to know." The PTZ cameras solicitation is a five-year term contract commencing on or about September 1, 2026, with the effective date occurring upon City Council award and signature and recording by the City Clerk's department, whichever is later. The solicitation is posted through the City's Procurement Portal and is subject to termination upon reaching the end of the term or through provisions outlined in the agreement itself.
Authorized representatives and their companies must sign the acknowledgement form, certifying their agreement to comply with federal regulations regarding the controlled documents. Signatories commit to destroying all specified documents upon the earlier of either their company's completion of its need to review and use the materials or the current contract end date. The form requires completion of specific fields including document titles, project name, contract end date, company name, authorized representative information, and contact details. This acknowledgement is a mandatory compliance requirement for any party seeking access to sensitive aviation security documentation related to the PTZ cameras procurement.
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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
File details come from the government source that posted it. Updated .