Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Concrete Flatwork Services
- Solicitation number
- IFB 26-0078
- Issued by
- Maricopa County, Phoenix City, 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 contract opportunity. The form is associated with a Concrete Flatwork Services solicitation for a five-year contract scheduled to commence on or about June 1, 2026. The contract will be awarded through the City's Procurement Portal, with the effective date determined by either the specified start date or upon City Council award and recording by the City Clerk's department. The contract can terminate at the end of its term or through specific provisions outlined in the agreement.
The acknowledgement form emphasizes strict compliance with federal regulations (49 C.F.R. Parts 15 and 1520) regarding sensitive security information, requiring signatories to handle documents with controlled access and destroy them upon contract completion or by the specified end date. Potential contractors must designate an authorized representative who will sign the form, providing company details, contact information, and agreeing to the specified information handling and destruction protocols. The solicitation is specific to Phoenix, Arizona, and seeks concrete flatwork services with provisions for careful information management and security.
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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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