Attachment J-8 (Statement and Acknowledgment).pdf

PDF 567 KB Posted Oct 19, 2020

Attached to: Operation of San Jose Job Corps Center
Solicitation number: 1605JW-20-R-00005
Issued by: Department of Labor Employment and Training Administration

About this file

Written by GovTribe AI · Dec 28, 2023

This document is a template for a Statement and Acknowledgment form required for subcontracting on federal prime contracts. It requires identification of the prime contract and subcontractor details including names, addresses, and contact information. The form also requires acknowledgment that standard clauses on labor standards, prevailing wage rates, overtime pay, and subcontracting flow down to any intermediate subcontractors. Fields are provided to list any intermediate subcontractors and obtain signatures from the prime contractor and subcontractor with dates to finalize the agreement.

The related federal solicitation is for operation of the San Jose Job Corps Center. It seeks an operator to provide vocational training, academic training, residential living, and other support services to help disadvantaged youth and young adults obtain career skills. The Department of Labor Employment and Training Administration issued the solicitation, with an opportunity type listed as a solicitation. No other details are provided on response due dates, award timing, or pricing terms in the information given.

View the file

Other files

File	Type	Posted
Amendment 2.pdf	PDF	Oct 21, 2020
Attachment J-1 (Price Detail Template).xlsx	XLSX spreadsheet	Oct 19, 2020
Amendment 1.pdf	PDF	Oct 19, 2020
Attachment J-22 (GSA Vehicles List).zip	ZIP file	Oct 19, 2020
Requests for Clarification and Government Responses (San Jose).pdf	PDF	Oct 19, 2020
How to View RFP Attachments.pdf	PDF	Sep 8, 2020
Solicitation for San Jose Job Corps Center (Revised 9-8-2020).pdf	PDF	Sep 8, 2020

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

STATEMENT AND ACKNOWLEDGMENT OMB Control Number: 9000-0066 Expiration Date: 4/30/2022

PART I - STATEMENT OF PRIME CONTRACTOR

1. PRIME CONTRACT NUMBER 2. DATE SUBCONTRACT

AWARDED

3. SUBCONTRACT NUMBER

15b. TITLE OF PERSON SIGNING

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1413 (REV. 4/2013)

Prescribed by GSA/FAR (48 CFR) 53.222(e)

4. PRIME CONTRACTOR 5. SUBCONTRACTOR

a. NAME a. NAME

b. STREET ADDRESS b. STREET ADDRESS

c. CITY d. STATE e. ZIP CODE c. CITY d. STATE e. ZIP CODE

6. The prime contract does, does not contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation."

7. The prime contractor states that under the contract shown in Item 1, a subcontract was awarded on the date shown in Item 2 to the subcontractor identified in item 5 by the following firm:

a. NAME OF AWARDING FIRM

b. DESCRIPTION OF WORK BY SUBCONTRACTOR

8. PROJECT 9. LOCATION

10a. NAME OF PERSON SIGNING 11. BY (Signature) 12. DATE SIGNED

10b. TITLE OF PERSON SIGNING

PART II - ACKNOWLEDGMENT OF SUBCONTRACTOR

13. The subcontractor acknowledges that the following clauses of the contract shown in Item 1 are included in this subcontract:

Construction Wage Rate Requirements Apprentices and Trainees Compliance with Copeland Act Requirements Subcontracts (Labor Standards) Contract Termination - Debarment Certification of Eligibility

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY

A C

B D

15a. NAME OF PERSON SIGNING 16. BY (Signature) 17. DATE SIGNED

The OMB control number for this collection is 9000-0066. We estimate that it will take .05 hours to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: U.S. General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

1.6 Presentation Agent PDFlib 3.02 (C++/Win32) D:20050617125503-04'00' D:20080212101247-05'00'

STATEMENT AND ACKNOWLEDGMENT

OMB Control Number: 9000-0066 Expiration Date: 4/30/2022

PART I - STATEMENT OF PRIME CONTRACTOR

1. PRIME CONTRACT NUMBER

2. DATE SUBCONTRACT AWARDED

3. SUBCONTRACT NUMBER

15b. TITLE OF PERSON SIGNING

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1413 (REV. 4/2013)

Prescribed by GSA/FAR (48 CFR) 53.222(e)

4. PRIME CONTRACTOR

5. SUBCONTRACTOR

a. NAME

b. STREET ADDRESS

c. CITY

d. STATE

e. ZIP CODE

c. CITY

d. STATE

e. ZIP CODE

6. The prime contract does, does not contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation."

7. The prime contractor states that under the contract shown in Item 1, a subcontract was awarded on the date shown in Item 2 to the subcontractor identified in item 5 by the following firm:

a. NAME OF AWARDING FIRM

b. DESCRIPTION OF WORK BY SUBCONTRACTOR

8. PROJECT

9. LOCATION

10a. NAME OF PERSON SIGNING

11. BY (Signature)

12. DATE SIGNED

10b. TITLE OF PERSON SIGNING

PART II - ACKNOWLEDGMENT OF SUBCONTRACTOR

13. The subcontractor acknowledges that the following clauses of the contract shown in Item 1 are included in this subcontract:

Contract Work Hours and Safety Standards Act - Overtime Compensation (If included in prime contract see Block 6) Payrolls and Basic RecordsWithholding of FundsDisputes Concerning Labor StandardsCompliance with Construction Wage Rate Requirements and Related Regulations Construction Wage Rate Requirements Apprentices and Trainees Compliance with Copeland Act Requirements Subcontracts (Labor Standards) Contract Termination - Debarment Certification of Eligibility

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY

A C B D 15a. NAME OF PERSON SIGNING

16. BY (Signature)

17. DATE SIGNED

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0066. We estimate that it will take .05 hours to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: U.S. General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

1. PRIME CONTRACT NUMBER:

4A. NAME:

4B. STREET ADDRESS:

4C. CITY:

7A. NAME OF AWARDING FIRM:

10A. NAME OF PERSON SIGNING:

15A. NAME OF PERSON SIGNING:

15B. TITLE OF PERSON SIGNING:

10B. TITLE OF PERSON SIGNING:

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line A.:

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line D.:

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line C.:

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line B.:

8. PROJECT:

9. LOCATION:

7B. DESCRIPTION OF WORK BY SUBCONTRACTOR:

5C. CITY:

4E. ZIP CODE:

5E. ZIP CODE:

4D. STATE:

5D. STATE:

3. SUBCONTRACT NUMBER:

5A. NAME:

5B. STREET ADDRESS:

2. DATE SUBCONTRACT AWARDED. Enter 2 digit month, 2 digit day and 4 digit year.:

12. DATE SIGNED. Enter 2 digit month, 2 digit day and 4 digit year.:

17. DATE SIGNED. Enter 2 digit month, 2 digit day and 4 digit year.:

6. The prime contract does contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 0

6. The prime contract does not contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 0

11. BY. SIGNATURE. This is a protected field.:

16. BY. SIGNATURE. This is a protected field.:

File details come from the government source that posted it. Updated Oct 19, 2020.