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
The document is a Sensitive Security Information Acknowledgement Form from the City of Phoenix Aviation Department. This form is designed to protect sensitive documents by requiring authorized representatives to acknowledge the confidential nature of certain materials controlled under federal regulations (49 C.F.R. Parts 15 and 1520). The form mandates that recipients understand the restrictions on document disclosure, maintain strict "need to know" protocols, and commit to destroying the documents upon completion of their review or by the contract's end date.
The associated contract opportunity is an Invitation for Bid (IFB-26-0146) issued by the City of Phoenix Water Services Department for procurement of hydrochloric and citric acid for three wastewater treatment plants. The solicitation covers multiple acid formulations in various container sizes, with estimated annual quantities of 25,000 gallons for hydrochloric acid totes, 550 gallons for drums, 20 gallons for 1-gallon containers, and 25,000 gallons for citric acid totes. Key requirements include a five-year contract term, contractor qualifications of minimum five years operational experience, mandatory safety data sheets, NSF compliance, and substantial Disadvantaged Business Enterprise (DBE) participation requirements. Contractors must maintain local inventory, provide returnable containers, and undergo background screening, with comprehensive insurance requirements including $2,000,000 in Commercial General Liability and $1,000,000 in Automobile Liability coverage.
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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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