Pa Dep Certified Drinking Water Operator

Trade Secret/Confidential Proprietary Information Notice
Instructions:
The Commonwealth may not assert on behalf of a third party an exception to the public release
of materials containing information believed to be exempt from public disclosure, including
trade secrets or confidential proprietary information, unless the materials are accompanied, at the
time they are submitted, by this form or a document containing similar information. In addition,
in order to protect the safety and security of individuals, infrastructure, and information
technology systems, the Commonwealth requires third parties to designate as confidential any
information submitted by the third parties that, if disclosed, would be reasonably likely to
jeopardize safety or security.
It is the responsibility of the party submitting this form to ensure that all statements and
assertions made below are legally defensible and accurate. The Commonwealth will not provide
a submitting party any advice with regard to Pennsylvania's Right-to-Know Law, 65 P.S.
67.101-67.3104, or laws relating to trade secret or confidential proprietary information.
Name of submitting party:
Contact information for submitting party:
Please provide a brief overview of the materials that you are submitting (e.g. bid proposal,
quote, grant application, statement of work, technical schematics):
Please provide a brief explanation of why the materials are being submitted to the
Commonwealth (e.g. response to bid, RFP or RFQ #12345, application for grant XYZ being
offered by the Department of Health, documents required to be submitted under law ABC):

Please indicate if any information has been included that you believe is exempt from public
disclosure by checking the appropriate box below: (Note: Financial information submitted in
response to an RFP or IFB to demonstrate economic capability is exempt from public disclosure in
accordance with Section 708(b)(26) of the Right-to-Know Law, 65 P.S. 67.708(b)(26)).
No information has been included that I believe is exempt from public
disclosure.
Information has been included that I believe is exempt from public
disclosure.
Please provide a list detailing which portions of the material being submitted you believe
are exempt from public disclosure. This includes trade secret, confidential or proprietary
information, or information that if disclosed would be reasonably likely to jeopardize the
safety or security of an individual, infrastructure, or information technology system.
Please provide an explanation of why you think those materials constitute a trade secret,
confidential or proprietary information, or why disclosure of those materials would be
reasonably likely to jeopardize safety or security. Also, please mark the submitted material
in such a way to allow a reviewer to easily distinguish between the parts referenced below.
(You may attach additional pages if needed)
Note: Without substantial justification, the following information will not be considered
a trade secret or confidential proprietary information:
* Any information submitted as part of a vendor's cost response.
* Information submitted as part of a vendor's technical response or
statement of work that does not implicate safety and security, or pertain
to specific business practices or product specification.
* Information submitted as part of a vendor's technical or small diverse
business and small business response that is otherwise publicly available
or otherwise easily obtained.
* Information detailing the name, quantity, and price paid for any product
or service being purchased by the Commonwealth.
Page Number Description Explanation

Acknowledgment
The undersigned party hereby agrees that it has read and completed this form, and has marked the
material being submitted in accordance with the instructions above. The undersigned party
acknowledges that the Commonwealth is not liable for the use or disclosure of trade secret,
confidential or proprietary information, or information that if disclosed would be reasonably likely
to jeopardize the safety or security of an individual, infrastructure or information technology
system, where that data or information has not been clearly marked as such, and which was not
accompanied by a specific explanation included with this form.
The undersigned agrees to defend any action seeking release of the materials it believes to be trade
secret, confidential or proprietary, or would be reasonably likely to result in a safety or security
risk if disclosed. The undersigned also agrees to indemnify and hold harmless the
Commonwealth, its agents and employees, from any judgments awarded against the
Commonwealth in favor of the party requesting the materials, and any and all costs connected
with that defense. This indemnification survives so long as the Commonwealth has possession of
the submitted material, and will apply to all costs unless and until the undersigned provides a
written statement or similar notice to the Commonwealth stating that it no longer wishes to
exempt the submitted material from public disclosure.
The undersigned acknowledges that the Commonwealth is required to keep all records for at least
as long as specified in its published records retention schedule.
The undersigned acknowledges that the Commonwealth reserves the right to reject the
undersigned's claim that the information is trade secret, confidential, proprietary or is reasonably
likely to result in a safety or security risk if disclosed, if the Commonwealth determines that the
undersigned has not met the burden of establishing that the information constitutes a trade secret,
confidential, or is otherwise exempt. The undersigned also acknowledges that if only a certain
part of the submitted material is found to constitute a trade secret, is confidential or proprietary, or
is otherwise exempt, the remainder of the submitted material will become public; only the
protected information will be removed and remain nonpublic.
If being submitted electronically, the undersigned agrees that the mark below is a valid electronic
signature.
Signature Title Date