Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Head Start Birth to Five Professional Development Training
Solicitation number
RFQu-EED-27-0422
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 conjunction with a procurement opportunity. The form serves as a binding acknowledgment that recipients of sensitive security information controlled under 49 C.F.R. Parts 15 and 1520 understand the restrictions on disclosure and agree to comply with federal regulations governing the handling of such materials. The form requires authorized company representatives to acknowledge receipt of specified documents, certify their understanding of the "need to know" limitations, and commit to destroying the documents upon either completion of the review period or by a specified contract end date, whichever occurs earlier.

The acknowledgement form contains placeholder fields for document titles, project names, contract end dates, and authorized representative information. Signing parties agree that unauthorized release of the sensitive security information may result in civil penalties or other legal action, and that public disclosure for U.S. government agencies is governed by the Freedom of Information Act (5 U.S.C. 552) in conjunction with the cited federal aviation security regulations. This form is typically executed prior to the receipt of security-sensitive procurement documents and serves as a prerequisite condition for vendors and contractors seeking to participate in aviation-related contracts with the City of Phoenix.

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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

File details come from the government source that posted it. Updated .