Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Traffic Sign Blanks
Solicitation number
IFB-26-0332
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 state and local contract opportunity for traffic sign blanks in Arizona. The form is required to be executed by authorized representatives of companies participating in the solicitation, which invites sealed offers for traffic sign blanks with an effective date upon final signature and recording by the City Clerk's department. The commencement date is scheduled for on or about December 2, 2026, 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 will terminate upon the earliest occurrence of reaching the end of the term or termination pursuant to the agreement's provisions. Sealed offers must be submitted through the City's Procurement Portal, with technical support available through the portal's support bubble or via email at procurement-support@opengov.com.

The acknowledgement form requires authorized company representatives to acknowledge that documents related to the traffic sign blanks solicitation contain Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520 and may only be disclosed to persons with requisite need to know. Signatories agree to destroy the specified documents upon the earlier of the company's completion of its need to review and use the documents or no later than the current contract end date, with unauthorized release subject to civil penalties or other action. The form requires completion of the signatory's name, title, phone number, and address by the authorized representative.

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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 .