Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Supply of Industrial Pipe, Miscellaneous Fittings, and Equipment
Solicitation number
IFB 27-SW-0447
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 contract opportunity involving the supply of industrial pipe, miscellaneous fittings, and equipment. The form template is designed to be completed and signed by authorized representatives of companies bidding on or awarded contracts with the City of Phoenix. The industrial pipe and equipment supply contract is scheduled to commence on or about December 1, 2026, and will run for an initial three-year term with two optional one-year extensions available, for a potential maximum contract duration of five years. The contract will become effective upon City Council award, provided the City Clerk's department executes and records the agreement as required by Phoenix City Code.

The acknowledgement form addresses compliance with federal security regulations governing sensitive security information under 49 C.F.R. Parts 15 and 1520. Signatories agree that documents containing sensitive security information may only be disclosed to persons with a demonstrated "need to know" and acknowledge that unauthorized release may result in civil penalties or other legal action. Companies must certify their commitment to destroying all controlled documents upon the earlier of either completion of their business need or the contract end date, in full compliance with applicable federal regulations. The form requires completion of specific fields including the document titles, project name, contract end date, company name, authorized representative information, and company address.

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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

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