Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Peer Recovery Support Specialists
- Solicitation number
- RFP PS-26-0308
- 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 Peer Recovery Support Specialists contract opportunity in Arizona. The City of Phoenix is seeking sealed offers for peer recovery support specialist services, with an effective date upon final signature and recording by the City Clerk's department. The commencement date is March 31, 2027, or the contract term start date approved by Phoenix City Council, whichever is later. The contract term is for two years beginning on the commencement date, with three one-year renewal options that may be exercised at the City's sole discretion. The agreement terminates upon the earliest occurrence of reaching the end of the contract term including any extensions or upon termination pursuant to the agreement's provisions. Solicitation materials are available through the City's Procurement Portal, with technical support available through the portal's support feature or at procurement-support@opengov.com.
The acknowledgement form requires that all contractors and authorized representatives sign and acknowledge the handling of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. Signatories must certify they understand that unauthorized release of this information may result in civil penalties or other legal action, and they agree to destroy designated documents upon completion of their need to review and use them or no later than the contract end date. All company representatives accessing sensitive information must provide their printed name, signature, title, phone number, and complete address on the form prior to receiving any restricted documents.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .