Sensitive_Security_Information_Acknowledgement_Form.docx
DOCX document 20 KB Posted
- Attached to
- Hydrochloric and Citric Acid
- Solicitation number
- IFB-26-0104
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
The provided document is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department, designed to protect confidential documents related to government projects. The form requires signatories to acknowledge the sensitive nature of specific documents controlled under 49 C.F.R. Parts 15 and 1520, with strict guidelines for handling, disclosure, and eventual destruction of the materials. Signatories must agree to protect the information, only sharing with persons who have a verified "need to know" and destroying the documents by the contract's end date.
The associated contract opportunity involves the City of Phoenix Water Services Department's procurement of hydrochloric and citric acid through Invitation for Bid IFB-26-0104. The five-year contract, scheduled to commence around November 15, 2025, seeks specific acid solutions including 31.45% hydrochloric acid in 330-gallon totes, 30% hydrochloric acid in 55-gallon drums and 1-gallon containers, and 50% citric acid in 330-gallon totes. The solicitation includes comprehensive Disadvantaged Business Enterprise (DBE) and Small Business Participation Plan requirements, mandating monthly tracking and reporting of DBE participation, with contractors required to demonstrate good faith efforts in engaging certified DBE suppliers.
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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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