Attachment 19 - SF1413 Statement and Acknowledgment.pdf

Standard Form PDF 768 KB Posted

Attached to
Running Track Resurface & Parking Lot Enlargement
Solicitation number
70LGLY22BSSB00001
Issued by

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Other versions and copies of SF 1413

568 government files on GovTribe name SF 1413. Different revisions are separate documents; copies of this exact file point search engines to its first posting.

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

Agency Files
Department of Transportation Federal Aviation Administration Northwest Mountain Region 122
Department of the Interior US Geological Survey Office of Acquisitions and Grants 83
Department of Energy Fermi National Accelerator Laboratory 58
Department of the Interior Bureau of Indian Affairs Bureau of Indian Education 46
Department of Energy Office of Science 35
Department of Veterans Affairs National Cemetery Administration 28
Department of Homeland Security US Coast Guard 28
Department of Labor Employment and Training Administration 16
State Files
Florida 3
Colorado 1

Other files

File Type Posted
Request for Information Question and Answers Aug 2 2022.pdf PDF
Attachment 22 - SF LLC - Disclosure of Lobbying Activities.pdf PDF
Attachment 12a - FTC OSPR 17 - Badge Application form for Contractors.pdf PDF
Attachment 11 - DHS 11000-6 - Non-Disclosure Agreement.pdf PDF
Attachment 4 - SF 28 - Affidavit of Individual Surety.pdf PDF
Attachment 14 - OF 306 - Contractors Declaration of Federal.pdf PDF
Attachment 8 - Instruction for Completing WH-347.pdf PDF
Attachment 10 - FMD 42 - Daily Report.pdf PDF
Attachment 21- SF 24 - Bid Bond.pdf PDF
Attachment 3 - SF 25A - Payment Bonds.pdf PDF
Attachment 6 - Format for Financial Institution.pdf PDF
Attachment 16 - Security Handout.pdf PDF
Attachment 1 - Statement of Work and Specifications.pdf PDF
Attachment 20 - SF 1444 - Request for Authorization of Additional Classification and Rate.pdf PDF
Attachment 5 - Format for Irrevocable Letter of Credit.pdf PDF
2.2.1 Solicitation Revised Bid Schedule Exhibit A.xlsx XLSX spreadsheet
Attachment 13a - Instructions for Employment Eligibility Verification Form.pdf PDF
Attachment 25 - WH 1321 - DOL Poster.pdf PDF
Attachment 9 - WH 347 - Wage and Hour Division.pdf PDF
Attachment 2 - SF 25 - Performance Bonds.pdf PDF
Attachment 18 - GA Construction Requirements Statute Wage Determination Highway GA20220248.pdf PDF
Attachment 26 - FLETC Form 121-00-02 Visitor Access Request.pdf PDF
2.2.1 70LGLY22BSSB00001 Resurface Running Track at Bldg. 256.pdf PDF
Attachment 7 - FTC.FMD -70 Invoice Cover Sheet.pdf PDF
Attachment 17 - Security Training List.pdf PDF
Attachment 24 - DHS 700-3 - Contractor Release Form.pdf PDF
Attachment 23 - Financial Questionnaire.pdf PDF
Attachment 13b - USCIS Form I-9.pdf PDF
Attachment 12b - FTC-OSPR-17Z.pdf PDF
Attachment 15 - SF 85 - Questionnaire for Non-Sensitive Positions.pdf PDF
Show all 30

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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.:

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