Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Pallet Recycling (wood only)
- Solicitation number
- IFB-26-0386
- 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. The form serves as a template for acknowledging receipt and understanding of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The form requires authorized representatives to confirm their awareness that the documents may only be disclosed to persons with a demonstrated "need to know" and that unauthorized release may result in civil penalties or other legal action. Signatories agree to destroy the specified documents upon the earlier of either their company's completion of its need to review and use the documents or by a specified contract end date, in compliance with applicable federal regulations.
The form is a standard administrative document designed to protect sensitive aviation security information and ensure compliance with federal disclosure restrictions. It does not contain specific contract terms, pricing information, deliverables, or project timelines. Rather, it functions as a prerequisite acknowledgement that contractors and other parties must sign before accessing restricted security-related documentation related to the City of Phoenix Aviation Department's operations or projects.
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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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