Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Emergency Temporary Housing
Solicitation number
RFQu-26-0295
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 related to an Emergency Temporary Housing contract opportunity in Arizona. The form serves as a compliance document for the Emergency Temporary Housing solicitation, which is being offered by the City of Phoenix through sealed competitive bidding. The solicitation is available through the City's Procurement Portal, with technical support available through the portal's support system or via email to procurement-support@opengov.com. The contract is designated with no specific value or commencement date in the available documentation, with the effective date to be determined upon City Council award, conditional upon signature and recording by the City Clerk's department per Phoenix City Code requirements. The agreement will terminate upon the earliest occurrence of reaching the end of the contract term, including any extensions exercised, or upon termination pursuant to the agreement's provisions.

The Sensitive Security Information Acknowledgement Form requires authorized representatives from bidding companies to acknowledge receipt of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520, which restrict disclosure to persons with requisite "need to know." Signatories agree to destroy specified documents upon the earlier of their company's completion of review and use or upon the contract end date, in compliance with federal aviation security regulations. Unauthorized release of such information may result in civil penalties or other legal action. The form requires completion of document titles, project name, contract end date, and authorized representative information including printed name, signature, title, phone number, 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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