Attachment_7_SF-1413_Statement_and_Acknowledgement_Form_(Subcontracting).pdf
PDF 70 KB Posted
- Attached to
- MINI SPLIT HEATING/COOLING Federal contract opportunity
- Solicitation number
- 140A2324R0099
About this file
This document is a Standard Form 1413, Statement and Acknowledgment, which is a required form for subcontracting under federal contracts. The prime contractor awarded a subcontract on the date shown to the identified subcontractor. The subcontractor acknowledges inclusion of specific federal contract clauses in the subcontract, including Contract Work Hours and Safety Standards Act, Payrolls and Basic Records, Withholding of Funds, and others. The form provides details on the prime contract number, subcontract number, project, and location. It is related to a federal contract opportunity for MINI SPLIT HEATING/COOLING, solicited by the Department of the Interior, Bureau of Indian Affairs, Bureau of Indian Education.
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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
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
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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.
File details come from the government source that posted it. Updated .