ATT 17 - Statement and Acknowledgement.pdf
PDF 70 KB Posted
- Attached to
- FLETC Charleston Construction IDIQ Contract Federal contract opportunity
- Solicitation number
- 70LCHS26RPFB00001
About this file
This document is a Standard Form 1413 (Statement And Acknowledgment) for documenting subcontract labor standards and wage requirements. The form is designed to capture details about a prime contract and associated subcontract, with sections for both the prime contractor and subcontractor to acknowledge various labor-related contract clauses. Key administrative details include an OMB Control Number of 9000-0066 and an expiration date of 5/31/2025. The form requires completion of multiple sections including prime contract number, subcontract details, project location, and acknowledgment of specific labor standards clauses such as Contract Work Hours and Safety Standards Act, Payrolls and Basic Records, Construction Wage Rate Requirements, and Apprentices and Trainees. The form is prescribed by GSA/FAR and is meant to ensure compliance with federal labor standards in subcontract agreements.
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Text version
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
File details come from the government source that posted it. Updated .