A8_SF1413_Statement_and_Acknowledgement.pdf
PDF 768 KB Posted
- Attached to
- CON Qrts Renovation
- Solicitation number
- 140A2325R0041
About this file
This document is a Standard Form 1413 (Statement and Acknowledgment), which is a federal contract form used to document subcontractor details and labor standards compliance. The form is designed to capture information about a prime contractor's subcontract, including details about the prime contract, subcontractor identification, and acknowledgment of specific labor-related contract clauses. The form includes two primary parts: Part I for the prime contractor's statement and Part II for the subcontractor's acknowledgment. Key administrative details include an OMB Control Number of 9000-0066 with an expiration date of 5/31/2025, and the form is prescribed by GSA/FAR (48 CFR) 53.222(e). The form requires signatures and documentation of various labor standards clauses, such as Contract Work Hours and Safety Standards Act, Construction Wage Rate Requirements, and Apprentices and Trainees provisions.
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STATEMENT AND ACKNOWLEDGMENT OMB Control Number: 9000-0066 Expiration Date: 5/31/2025
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:
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 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.
1.6 Presentation Agent PDFlib 3.02 (C++/Win32) D:20050617125503-04'00' D:20080212101247-05'00' Presentation Agent Standard Form 1413 - Statement and Acknowledgment
STATEMENT AND ACKNOWLEDGMENT
OMB Control Number: 9000-0066 Expiration Date: 5/31/2025
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:
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 |
| Sign here if you are the Subcontractor.: |
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