Sensitive_Security_Information_Acknowledgement_Form.docx

DOCX document 20 KB Posted

Attached to
Emergency Call Systems Monitoring and Maintenance (TAL)
Solicitation number
IFB FY27-086-08
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This file is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department for use in connection with a contract opportunity for Emergency Call Systems Monitoring and Maintenance. The form serves as a template requiring authorized representatives from bidding companies to acknowledge receipt of documents containing Sensitive Security Information governed by 49 C.F.R. Parts 15 and 1520. Signatories must confirm their understanding that the documents may only be disclosed to persons with a demonstrated "need to know" and agree to destroy such documents upon completion of their review or use, or no later than the contract end date specified by the City. The form requires completion of recipient company name, authorized representative information including printed name, signature, title, phone number, and full address.

The acknowledgement form reflects the City of Phoenix's security protocols for protecting sensitive aviation-related information during the procurement process for emergency call system services. No specific pricing terms, set-asides, funding amounts, or other financial details are contained in this particular document, as it functions solely as a security compliance instrument. The form is a mandatory component of the broader solicitation process and establishes legal accountability for all parties receiving sensitive materials related to the Emergency Call Systems Monitoring and Maintenance contract opportunity.

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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 .