Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Heavy Duty Truck Brake Services
- Solicitation number
- IFB-26-FSD-0412-2
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This file is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department that applies to a Heavy Duty Truck Brake Services contract opportunity in Arizona. The form serves as a template for individuals and representatives to acknowledge receipt of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. Signatories agree to restrict disclosure to those with a demonstrated need to know and commit to destroying the documents upon completion of their review and use or by the contract end date, whichever occurs first. Unauthorized release of this information may result in civil penalties or other action as governed by 5 U.S.C. 552 and applicable federal regulations.
The related Heavy Duty Truck Brake Services solicitation is a sealed competitive procurement from the City of Phoenix with an effective date upon final signature and recording by the City Clerk. The agreement will commence on or about January 1, 2027, with an initial three-year term and two optional one-year extensions exercisable at the City's sole discretion. The solicitation is available through the City's Procurement Portal, with technical support available through the portal's support bubble or by email to procurement-support@opengov.com. The contract will terminate upon the earliest occurrence of reaching the end of the term including any exercised extensions or termination pursuant to agreement provisions.
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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
File details come from the government source that posted it. Updated .