Appendix I - SF1413-23.pdf

701 KB Posted

Attached to
RFP SC-25-637 Ames Infrastructure Modernization Project with RFP Addendums
Solicitation number
RFP-SC-25-637
Issued by

About this file

Written by GovTribe AI ·

This document is a Standard Form 1413 (SF 1413) - Statement and Acknowledgment, which is a federal contracting form used to document the relationship between a prime contractor and a subcontractor.

The key details are:

  • Prime Contract Number: DE-AC02-07CH11358
  • Subcontract Number: SC-25-637
  • Prime Contractor: Ames National Laboratory
  • Subcontractor: (name and address not provided)
  • Subcontract Awarded: (date not provided)
  • Description of Subcontractor's Work: Construction for Ames Infrastructure and Modernization Project to include electrical upgrades, plumbing upgrades, new roofs and information technology room upgrades.
  • Project Name: SC-25-637
  • Project Location: Ames Laboratory, Ames, IA/Iowa State University
  • Awarding Firm: Ames National Laboratory

The document also indicates that the prime contract contains the "Contract Work Hours and Safety Standards Act - Overtime Compensation" clause.

View the file

Other files

File Type Posted
RFP SC-25-637 Addendum 6 dated 11-20-2024.pdf PDF
RFP SC-25-637 Addendum 5.pdf PDF
RFP SC-25-637 Addendum 4.pdf PDF
RFP SC-25-637 Addendum 3 Complete 10-29-2024.pdf PDF
RFP SC-25-637 Addendum 2 with Attachment 1 dated 10-17-2024.pdf PDF
RFP SC-25-637 AIM Project - Addendum 1 with attachments 10-07-2024.pdf PDF
Appendix B - Specifications and Drawings dated 09-26-2024 Rev.0.pdf PDF
Appendix A - Ames Lab Ts and Cs for FP Construction Services_Oct 2023.pdf PDF
Appendix E - Small Business Plan Template.pdf PDF
Appendix B - Specifications and Drawings dated 09-26-2024 Rev.0.pdf PDF
Appendix F - AIM Safety Appendix 07162024-kk (1).pdf PDF
Appendix K - Sample Fixed Price Construction Contract.pdf PDF
Appendix A1 - ESH Ts and Cs - Sept. 5, 2024.pdf PDF
Appendix C - Story County WD IA20240074 Mod. 9 dated 08-16-2024.pdf PDF
Appendix D10 - Construction requiring delivery of data 06242021.pdf PDF
Appendix G - Affirmation and Certification of Subcontract Terms and Conditions.pdf PDF
RFP SC-25-637 Ames Infrastructure Modernization Project.pdf PDF
Appendix H - Reps and Certs Supplemental 12-8-2022 (1).pdf PDF
Appendix J - Contractor Safety and Quality Assurance Information Questionnaire.pdf PDF
Show all 19

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: 5/31/2025

Part I - Statement Of Prime Contractor

1. Prime Contract Number 2. Date Subcontract

Awarded

3. Subcontract Number

Authorized For Local Reproduction Previous Edition Is Not Usable

STANDARD FORM 1413 (REV. 10/2023)

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

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.

15b. Title Of Person Signing

15a. Name Of Person Signing 16. By (Signature) 17. Date Signed

14. Name(s) Of Any Intermediate Subcontractors, If Any

A C

DB

STANDARD FORM 1413 (REV. 10/2023) BACK

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 Authorized For Local Reproduction Previous Edition Is Not Usable

STANDARD FORM 1413 (REV. 10/2023)

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 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.

15b. Title Of Person Signing 15a. Name Of Person Signing

16. By (Signature)

17. Date Signed

14. Name(s) Of Any Intermediate Subcontractors, If Any A C D B

STANDARD FORM 1413 (REV. 10/2023) BACK

1. Enter the Prime Contract Number. : DE-AC02-07CH11358
4a. Enter the Prime Contractor's Name. : Ames National Laboratory
4b. Enter the Prime Contractor's Street Address. : 2408 Pammel Drive, 231 TASF
4c. Enter the Prime Contractor's City.: Ames
7a. Enter the Name of the Awarding Firm.: Ames National Laboratory
10a. Enter the Name of the Person signing this form as the Prime Contractor. : Andrew Saxton
10b. Enter the Title of the Person signing this form as the Prime Contractor. : Contract Manager
8. Enter the Project name.: SC-25-637
9. Enter the Location. : Ames Laboratory, Ames, IA/Iowa State University
7b. Enter a Description of Work completed by the Subcontractor. : Construction for Ames Infrastructure and Modernization Project to include electrical upgrades, plumbing upgrades, new roofs and information technology room upgrades.
5c. Enter the Subcontractor's City.:
4e. Enter the Prime Contractor's Zone Improvement Plan (ZIP) Code. : 50011-1015
5e. Enter the Subcontractor's Zone Improvement Plan (ZIP) Code. :
4d. Enter the Prime Contractor's State.: IA
5d. Enter the Subcontractor's State.:
3. Enter the Subcontract Number. : SC-25-637
5a. Enter the Subcontractor's Name.:
5b. Enter the Subcontractor's Street Address.:
2. Enter the Date the Subcontract was Awarded (enter 2 digit month, 2 digit day and 4 digit year).:
12. If you are the Prime Contractor, enter the Date you signed this form (enter 2 digit month, 2 digit day and 4 digit year).:
6. Click here to select, "the prime contract does contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 1
6. Click here to select, "the prime contract does NOT contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 0
16. Sign here if you are the Subcontractor.:
15b. Enter the Title of the Person Signing this form as the Subcontractor. :
15a. Enter the Name of the Person Signing this form as the Subcontractor. :
17. If you are the Subcontractor, enter the Date you signed this form (enter 2 digit month, 2 digit day and 4 digit year).:
14a. Enter the First Name of an Intermediate Subcontractor, If Any. :
14c. Enter the Third Name of an Intermediate Subcontractor, If Any.:
14d. Enter the Fourth Name of an Intermediate Subcontractor, If Any.:
14b. Enter the Second Name of an Intermediate Subcontractor, If Any.:

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