Attachment J - SF 1413 Statement and Acknowledgement for Subcontractors.pdf
PDF 567 KB Posted
- Attached to
- New Fort Bliss Paving IDIQ Contract
- Solicitation number
- W911SG27BA002
About this file
This is Standard Form 1413 (Rev. 4/2013), a federal contracting template used to document and acknowledge subcontracts awarded under a prime federal contract. The form serves as a binding statement between the prime contractor and subcontractor, ensuring compliance with labor standards and contract requirements.
Part I requires the prime contractor to provide the prime contract number, subcontract award date, and subcontract number, along with identifying information for both the prime contractor and subcontractor (name and address). The prime contractor must indicate whether the prime contract contains the "Contract Work Hours and Safety Standards Act – Overtime Compensation" clause and identify the firm awarding the subcontract along with a description of the work to be performed. Part II requires the subcontractor to acknowledge receipt and inclusion of specific federal labor standards clauses, including provisions related to contract work hours and safety, payroll and records, withholding of funds, wage rate requirements, apprentices and trainees, Copeland Act compliance, subcontracts, contract termination and debarment, and certification of eligibility. The form also provides space to list any intermediate subcontractors. Both the prime contractor and subcontractor representatives must sign and date the form. The OMB control number is 9000-0066, with an estimated completion time of 0.05 hours, and the form is authorized for local reproduction.
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STATEMENT AND ACKNOWLEDGMENT OMB Control Number: 9000-0066 Expiration Date: 4/30/2022
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'
STATEMENT AND ACKNOWLEDGMENT
OMB Control Number: 9000-0066 Expiration Date: 4/30/2022
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 |
| 11. BY. SIGNATURE. This is a protected field.: |
| 16. BY. SIGNATURE. This is a protected field.: |
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