Sensitive_Security_Information_Acknowledgement_Form.pdf

PDF 78 KB Posted

Attached to
Low-Voltage Infrastructure Services
Solicitation number
IFB 27-0420
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This file is a Sensitive Security Information Acknowledgement Form issued by the City of Phoenix Aviation Department for use in conjunction with a Low-Voltage Infrastructure Services contract opportunity in Arizona. The form requires authorized representatives of companies receiving sensitive security information to acknowledge compliance with federal regulations governing the protection and disclosure of such information under 49 C.F.R. Parts 15 and 1520. The Low-Voltage Infrastructure Services contract solicitation invites sealed offers for maintenance, repair, replacement, and support services for low-voltage systems, with a commencement date of April 1, 2027, or the effective date (upon final signature and recording by the City Clerk), whichever is later. The contract term is five years from the commencement date with no options to extend, and the agreement will terminate upon the earliest occurrence of reaching the end of the term or termination pursuant to contract provisions. The solicitation is available through the City's Procurement Portal.

Signatories to the acknowledgement form agree to comply with federal security information protocols and to destroy all documents containing sensitive security information upon the earlier of the company's completion of its need to review and use the documents or no later than the current contract end date. The form requires completion of specific fields including document titles, project name, and contract end date. No pricing information, set-asides, incumbent status, or funding details are specified in this acknowledgement form itself; such information would be contained in the primary solicitation documents.

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Attachment B 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

File details come from the government source that posted it. Updated .