Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Anchor Points Inspections, Testing, and Repair
Solicitation number
IFB-27-0458
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 the Anchor Points Inspections, Testing, and Repair contract opportunity in Arizona. The form serves as a template for authorized representatives of companies bidding on or participating in the project to acknowledge receipt and understanding of documents containing Sensitive Security Information governed by 49 C.F.R. Parts 15 and 1520. Signatories agree to restrict disclosure of the specified documents to individuals with a demonstrated "need to know" and commit to destroying the materials upon completion of their review and use or by the contract end date, whichever occurs first. The contract itself is for anchor point inspections, testing, and repair services, with an effective date upon final signature and recording by the City Clerk's department and a commencement date on or after the Phoenix City Council-approved start date. The agreement term duration and any extension options are to be specified, with termination occurring upon the earliest of contract term expiration, including any exercised extensions, or termination pursuant to agreement provisions.

The acknowledgement form requires completion of document titles and project name fields and must be signed by an authorized company representative providing printed name, title, phone number, and full address. Unauthorized disclosure of Sensitive Security Information may result in civil penalties or other legal action, with public disclosure for U.S. government agencies governed by 5 U.S.C. 552 and the aforementioned federal aviation security regulations. Solicitation details and submission instructions are available through the City of Phoenix Procurement Portal, with technical support available through the portal's support feature or via email 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

______
TITLEPHONE NUMBER

ADDRESS CITY, STATE AND ZIP CODE

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