Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Hydrochloric and Citric Acid
- Solicitation number
- IFB-26-0146
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department, required for access to documents related to a Hydrochloric and Citric Acid contract opportunity. The form establishes protocol for handling materials classified as Sensitive Security Information under 49 C.F.R. Parts 15 and 1520, which are restricted to individuals with documented "need to know" access. Signatories—authorized company representatives—must acknowledge receipt of specified documents and commit to their destruction upon the earlier of either the completion of review and use or the contract end date. Unauthorized disclosure of this information may result in civil penalties or other legal action.
The form requires completion of specific fields including document title(s), project name, contract end date, and the authorized representative's company information, name, signature, title, phone number, and address. This acknowledgement is a standard requirement for City of Phoenix solicitations involving sensitive security materials and serves as a binding agreement between the contractor and the municipality regarding information protection and compliance with federal regulations governing sensitive aviation security documentation.
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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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