Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Trailer Mounted Water Pumps
- Solicitation number
- IFB 26-FSD-010
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
The document is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department. The form relates to a state and local contract opportunity for trailer mounted water pumps, which the City of Phoenix is seeking to procure for a 3-year period with two potential one-year extension options. The contract is anticipated to commence on or about July 01, 2025, with the effective date being either the contract award by City Council or upon signature and recording by the City Clerk's department, whichever occurs later.
The acknowledgement form emphasizes strict confidentiality requirements for handling sensitive security information, governed by federal regulations (49 C.F.R. Parts 15 and 1520). Authorized representatives signing the form must agree to destroy specified documents in compliance with these regulations, either upon completion of document review or by the contract's end date. While specific pricing details are not provided in this document, the form is a critical component of the procurement process, ensuring proper handling of sensitive information related to the trailer mounted water pumps contract for the City of Phoenix in Arizona.
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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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