Attachment_2_SF1413_Statement_and_Acknowledgement.pdf

768 KB Posted

Attached to
IE148-BLDG 110 EMERGENCY HVAC HOT WATER
Solicitation number
140A2326Q0165
Issued by

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This is Standard Form 1413 (Rev. 4/2013), a federal contracting template titled "Statement and Acknowledgment," prescribed by the General Services Administration and Federal Acquisition Regulation (FAR).

The form serves as a bilateral acknowledgment document between a prime contractor and subcontractor regarding labor standards clauses flow-down from a prime federal contract. Part I requires the prime contractor to provide the prime contract number, subcontract award date, subcontractor identification, awarding firm name, and description of subcontracted work, along with project and location details. The prime contractor must also indicate whether the Contract Work Hours and Safety Standards Act overtime compensation clause is included in the prime contract. Part II requires the subcontractor to acknowledge receipt and inclusion of ten specific labor standards clauses in the subcontract: Contract Work Hours and Safety Standards Act - Overtime Compensation; 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; and Certification of Eligibility. The form includes signature blocks for authorized representatives from both prime contractor and subcontractor, with space to identify any intermediate subcontractors. The OMB Control Number is 9000-0066 with an expiration date of May 31, 2025, and the estimated time to complete is 0.05 hours.

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Other files

File Type Posted
Sol_140A2326Q0165_Amd_0001.pdf PDF
Attachment_1_Statement_of_Work.pdf PDF
Sol_140A2326Q0165.pdf PDF
Attachment_3_Wage_Determination.pdf PDF
Attachment_4_IA_-_IEE_Representation_Form.pdf PDF
Attachment_5_TORFP_Questions_and_Answers_Log.xlsx XLSX spreadsheet

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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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