SF 1413.pdf

Standard Form PDF 313 KB Posted

Attached to
"THIS IS A SUBCONTRACTING OPPORTUNITY"
Solicitation number
2012-7
Issued by

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Other versions and copies of SF 1413

File Revision Posted Attached to
B2_DRAFT_08.3_Sec_J_SF1413_exp_05-2027.pdf May 2027 SLAC Job Order Contract
S02_Attachment - SF 1413 updated.pdf Revision not stated Fort Bliss National Cemetery, Gravesite Expansion and FCA Deficiencies
SF-1413_Statement_and_Acknowledgement_Form_(Subcontracting).pdf Revision not stated IE181 - WHS Greenhouse Construction
SF 1413-23A - Statement and Acknowledgment.pdf Revision not stated 70Z03026QCLEV0106 - USCG STA/ANT BUFFALO GENERATOR MAINTENANCE
B08_Attachment_9_Subcontractor_Ack_SF1413-23a_upon_award.pdf Revision not stated EROS Removal and replacement of chilled and conden
Exhibit I - Statement of Acknowledgment (SF-1413).pdf Revision not stated Central Utility Building Addition and Renovation Construction, UIP Subproject 1-CUB
S02_Attachment - Standard Form 1413.pdf Revision not stated Fort Bliss National Cemetery, Gravesite Expansion and FCA Deficiencies
S02_Attachment - Standard Form 1413.pdf Revision not stated CAMP NELSON NATIONAL CEMETERY, KY 833CM3030 – CORRECT FCA DEFICIENCIES
Exhibit K - SF1413.pdf Revision not stated Fire Sprinkler Repair_XGal_IB2A_Lab1_MI50
SF 1413-23A - Statement and Acknowledgment (2).pdf Revision not stated 70Z03026QCLEV0100 - GROUND MAINTENANCE AND SNOW REMOVAL FOR USCG STATION ST. IGNACE
SF 1413-23A - Statement and Acknowledgment (2).pdf Revision not stated 70Z03026QCLEV0101 - GROUND MAINTENANCE AND SNOW REMOVAL FOR SECTOR NORTHERN GRREAT LAKES
SF 1413 - Statement and Acknowledgment.pdf Revision not stated 70Z03026QCLEV0071 - USCG STA LORAIN SECURITY SYSTEM WITH CCTV PROJECT
Exhibit I SF1413_fill-ins.pdf Revision not stated MINOS High Bay Roof Replacement & Masonry Wall Repair
SF 1413 - Statement and Acknowledgment.pdf Revision not stated 70Z03026QCLEV0099 Replacement HVAC Station Building at STA Sodus Point
S02_Attachment - Standard Form 1413.pdf Revision not stated Leavenworth National Cemetery, Gravesite Expansion
SF 1413 - Statement and Acknowledgment.pdf Revision not stated 70Z03026QCLEV0097 - U. S. Coast Guard Station Lorain Gate Replacement
B08_Attachment_7_Subcontractor_Statement_and_Acknowledgment_SF1413-23a.pdf Revision not stated DREDGING OF SEDIMENT POND & CONTACT POOL
SF 1413-23A - Statement and Acknowledgment (1) (1).pdf Revision not stated 70Z03026QCLEV0053- USCG STATION ST. IGNACE REPLACEMENT SHOWER STALL
Exhibit K SF1413_printed.pdf Revision not stated Roof Maintenance and Repair Services IDIQ
SF1413 Statement of Acknowledgement.pdf Revision not stated CSS 99147 Mini Splits Scranton, PA (PA162)
Show all 20

Who attaches SF 1413

State Files
Florida 3
Colorado 1

Other files

File Type Posted
Vendor Item RFP List Food.xls XLS spreadsheet
General Purchase Order Terms and Conditions.docx DOCX document
Request for Proposal GJCC Food BID June-12.doc DOC document
Fixed_Price_Supply_-_Food_Products 1 .doc DOC document

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Text version

STATEMENT AND ACKNOWLEDGMENT OMB No.: 9000-0014 Expires: 6/30/2014

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat, (VIR), Regulatory and Federal Assistance Division, GSA, Washington, DC 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0014), Washington, DC 20503.

PART I - STATEMENT OF PRIME CONTRACTOR

1. PRIME CONTRACT NO. 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. 7/2005)

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:

Contract Work Hours and Safety Standards Act - Overtime Compensation - (If included in prime contract see Block 6) Payrolls and Basic Records Withholding of Funds Disputes Concerning Labor Standards Compliance with Davis-Bacon and Related Act Regulations

Davis-Bacon Act 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

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

STATEMENT AND ACKNOWLEDGMENT

OMB No.: 9000-0014 Expires: 6/30/2014 Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions,searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat, (VIR), Regulatory and Federal Assistance Division, GSA, Washington, DC 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0014), Washington, DC 20503.

PART I - STATEMENT OF PRIME CONTRACTOR

1. PRIME CONTRACT NO.

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. 7/2005)

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:

Contract Work Hours and Safety Standards Act - Overtime Compensation - (If included in prime contract see Block 6) Payrolls and Basic Records Withholding of Funds Disputes Concerning Labor Standards Compliance with Davis-Bacon and Related Act Regulations Davis-Bacon Act 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

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.:

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