Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Production Well Emergency Support
- Solicitation number
- IFB-27-0486
- 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 required for a contract opportunity related to Production Well Emergency Support in Arizona. The form serves as a template to be completed by authorized representatives of bidding companies and acknowledges receipt of documents containing Sensitive Security Information controlled under 49 C.F.R. Parts 15 and 1520. The signatory agrees on behalf of their company that the information will only be disclosed to individuals with requisite "need to know" and commits to destroying the documents upon the earlier of either completion of review and use or the contract end date, in compliance with applicable federal regulations. Unauthorized release of such information may result in civil penalties or other legal action.
The form requires completion of blanks identifying the specific document titles, project name, and contract end date. Signatories must provide their name, title, signature, phone number, and full company address. This acknowledgement is standard practice for government contracts involving security-sensitive materials and demonstrates the contractor's understanding of and commitment to protecting information governed by federal aviation security regulations and public disclosure laws.
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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 .