Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Spoils Hauling Services
- Solicitation number
- IFB-27-0434
- 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, which establishes protocols for handling restricted security documentation related to a state and local contract opportunity for spoils hauling services in Arizona. The form applies to specified documents containing Sensitive Security Information regulated under 49 C.F.R. Parts 15 and 1520, restricting disclosure to authorized personnel with a demonstrated need to know. The City of Phoenix seeks sealed offers for spoils hauling services under a five-year agreement with no extension options, commencing upon final city council approval and clerk recording. Contract execution and commencement details, as well as technical support for the City's Procurement Portal, are outlined in the related solicitation materials.
Signatories to this acknowledgement form must agree to comply with federal security regulations and destroy all restricted documents upon the earlier of project completion or the contract end date specified by the city. Unauthorized release of Sensitive Security Information may result in civil penalties or other legal action as prescribed under 49 U.S.C. Section 552 and applicable federal aviation security regulations. The form requires authorized company representatives to provide contact information, title, signature, and company address, formally binding the organization to confidentiality and proper document handling protocols throughout the contract period.
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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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