Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Variable Frequency Drives
- Solicitation number
- IFB-25-0749
- 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 documents related to a project. This form requires authorized representatives to acknowledge the sensitive nature of specific documents controlled under 49 C.F.R. Parts 15 and 1520, with strict guidelines for handling and destroying such information. The form must be signed by a company representative, including their name, signature, title, contact information, and address, and commits the signatory to destroy the referenced documents upon project completion or contract end date.
The associated contract opportunity is for Variable Frequency Drives (VFDs) issued by the City of Phoenix Water Services Department through Invitation for Bid (IFB-25-0749). The five-year contract, set to commence around September 15, 2025, seeks VFDs from ten specific manufacturers including Allen Bradley, Eaton/Cutler Hammer, Siemens, and others. Key procurement details include a non-mandatory pre-offer conference on May 15, 2025, question deadline of May 19, 2025, and final response deadline of May 28, 2025. The City reserves the right to purchase up to 100 percent of specified quantities and requires contractors to maintain local inventory. While no specific budget is outlined, the solicitation emphasizes Disadvantaged Business Enterprise requirements, non-discrimination provisions, and will be conducted through the City's OpenGov e-Procurement Portal.
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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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