Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Variable Frequency Drives State and local contract opportunity
- Solicitation number
- IFB-26-0087
- Issued by
- Maricopa County, Arizona
About this file
The document is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department, designed to protect confidential information related to a project involving variable frequency drives (VFDs). The form requires authorized representatives to acknowledge the sensitive nature of the documents, which are controlled under federal regulations 49 C.F.R. Parts 15 and 1520. The City of Phoenix Water Services Department is seeking a provider of VFDs with various horsepower ratings, model designations, and configurations, including manufacturer-specific accessories and product upgrades available for purchase during the contract term.
The acknowledgement form mandates that recipients can only disclose the documents to persons with a requisite "need to know" and must destroy the materials upon project completion or by the specified contract end date. Unauthorized release of the information may result in civil penalties. The VFD procurement is specific to Arizona, with the City of Phoenix Water Services Department seeking a comprehensive solution that allows for flexible purchasing of drives and related equipment throughout the contract period. The form emphasizes strict compliance with federal information protection guidelines and requires a signed commitment from the authorized company representative.
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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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