Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Animal Boarding Services
- Solicitation number
- RFQu-27-0399
- 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 to be utilized as part of an Animal Boarding Services contract opportunity. The form serves as a compliance document for the receipt of sensitive security information controlled under 49 C.F.R. Parts 15 and 1520. Authorized representatives who receive documents containing such sensitive information must acknowledge their understanding of disclosure restrictions and agree to destroy the materials upon the earlier of either completion of their need to review and use the documents or by the contract end date. The Animal Boarding Services contract is a five-year term beginning January 1, 2027 or upon the Effective Date, whichever is later, with no options to extend. The agreement will terminate upon reaching the end of the term or through termination provisions outlined in the contract.
The form requires authorized company representatives to provide their printed name, signature, title, phone number, and complete address to acknowledge receipt and understanding of the sensitive security information handling requirements. Unauthorized release of the controlled information may result in civil penalties or other legal action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 in conjunction with the applicable C.F.R. regulations. Interested offerors should access the solicitation through the City of Phoenix's Procurement Portal and contact the designated procurement officer for inquiries related to the solicitation, with technical support available through the portal's support feature or at procurement-support@opengov.com.
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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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