Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Traffic Signal Cabinet Art Wrap
- Solicitation number
- RFQu-26-0114
- 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 contract documents. The form relates to a Traffic Signal Cabinet Art Wrap solicitation, which invites sealed offers for art design on traffic signal cabinets for a three-year contract term, with two potential one-year renewal options. The contract is set to commence on or about January 1, 2026, and will be awarded through the City's Procurement Portal, with technical support available via email or an online support bubble.
The solicitation allows for flexible contract termination, ending upon reaching the maximum contract term or through specified agreement provisions. While specific pricing details are not provided in this document, the form emphasizes strict handling of sensitive information, requiring authorized representatives to acknowledge and comply with federal regulations (49 C.F.R. Parts 15 and 1520) regarding document disclosure and destruction. Potential bidders must carefully review and sign the acknowledgement form, which includes provisions for protecting sensitive security information and limiting access to individuals with a demonstrable "need to know."
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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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