Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Management Consulting Services
Solicitation number
RFQu-27-0477
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 a Management Consulting Services contract. The form establishes compliance requirements for parties handling documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The related contract opportunity is for Management Consulting Services through the City of Phoenix, with an effective date upon final signature and recording by the City Clerk's department and a commencement date of March 1, 2027, or the effective date, whichever is later. The contract term is five years from the commencement date with no extension options. The solicitation is available through the City's Procurement Portal, with technical support accessible through the portal or via procurement-support@opengov.com. The agreement terminates upon the earliest occurrence of reaching the end of the contract term or termination pursuant to agreement provisions.

Authorized representatives receiving sensitive security documents must acknowledge the restrictions on disclosure and agree to destroy the documents upon the earlier of completion of their need to review and use them or by the contract end date. Unauthorized release of Sensitive Security Information may result in civil penalties or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and the aforementioned federal regulations. The form requires completion of the authorized representative's name, signature, title, phone number, and company address before the documents can be released.

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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 .