Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Thermoplastic Pavement Marking Raw Material State and local contract opportunity
Solicitation number
IFB-26-0348
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 thermoplastic pavement marking raw material procurement solicitation. The form establishes protocols for protecting sensitive security information controlled under 49 C.F.R. Parts 15 and 1520 and requires authorized representatives from participating companies to acknowledge their responsibility to maintain confidentiality and restrict disclosure to personnel with a demonstrated need to know. The City of Phoenix invites sealed offers for thermoplastic pavement marking raw material through its Procurement Portal, with an agreement effective upon final signature and recording by the City Clerk's department. The commencement date is set for February 15, 2027, or the effective date, whichever is later. The contract term is five years from the commencement date with no options to extend, and the agreement terminates upon the earliest occurrence of reaching the end of the term or meeting termination provisions outlined in the agreement documentation.

Signatories to the acknowledgement form must commit to destroying all documents containing sensitive security information upon the earlier of their company's completion of its need to review and use the documents or the current contract end date. Unauthorized release of the sensitive security information may result in civil penalties or other legal action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and the applicable Code of Federal Regulations sections. The form requires completion of company name, authorized representative information, signature, title, phone number, and complete address before submission. Technical support for the Procurement Portal is available through the support function or by email to procurement-support@opengov.com, with additional solicitation inquiries directed to the designated procurement officer.

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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

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