Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Chiller and Boiler System Maintenance
- Solicitation number
- IFB FY27-086-03
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department related to a chiller and boiler system maintenance contract. The form establishes requirements for handling classified materials in accordance with 49 C.F.R. Parts 15 and 1520. The City of Phoenix has issued a solicitation for chiller and boiler system maintenance services through sealed competitive bidding via the City's Procurement Portal. The contract term is five years from the Commencement Date, which will be established upon Phoenix City Council approval and City Clerk recording, with no options to extend. The agreement will terminate upon the earlier of the end of the five-year term or termination pursuant to contract provisions.
Contractors and their authorized representatives who receive sensitive security information related to this procurement must acknowledge their obligation to maintain confidentiality and destroy all related documents upon completion of their review or use, or no later than the contract end date. Unauthorized disclosure of the sensitive security information may result in civil penalties or other action. The form requires signature and contact information from the authorized company representative affirming compliance with all applicable federal security information regulations. Technical support for the procurement portal is available through OpenGov, while other solicitation-related inquiries should be directed to the listed 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
| ______ | ||
| TITLE | PHONE NUMBER |
ADDRESS CITY, STATE AND ZIP CODE
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