Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Vactor Services - Requirements Contract
- Solicitation number
- IFB-27-0462
- 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 connection with a Vactor Services Requirements Contract in Arizona. The form serves as a template to be completed for specific projects and document titles, establishing that recipients understand the confidential nature of materials containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The vactor services contract is a five-year requirements contract with an effective date upon final signature and recording by the City Clerk's department, with the commencement date occurring on the contract term start date approved by Phoenix City Council or the effective date, whichever is later. The contract term is five years beginning on the commencement date with no options to extend, and will terminate upon the earliest occurrence of reaching the end of the term or termination pursuant to the agreement's provisions.
Authorized representatives of participating companies must sign the acknowledgement form, confirming their understanding that Sensitive Security Information may only be disclosed to persons with requisite "need to know" as defined in federal regulations, and that unauthorized release may result in civil penalties or other action. Signatories agree to destroy the specified documents in compliance with 49 C.F.R. Parts 15 and 1520 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. The solicitation is available through the City of Phoenix's Procurement Portal, with technical support provided through the portal's support feature or via procurement-support@opengov.com. For other solicitation-related inquiries, potential offerors should contact the designated procurement officer.
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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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