B08_Atch_10_Statement_and_Acknowledgement_SF1413-13e.pdf
PDF 567 KB Posted
- Attached to
- NETWORK WIRING - TUNISON AQUATICS LAB Federal contract opportunity
- Solicitation number
- 140G0224R0007
About this file
This document is a Statement and Acknowledgment form used between a prime contractor and subcontractor on a federal contract. It details that the subcontractor will perform work on Project and Location for Prime Contractor Name. The subcontract was awarded on Date by Awarding Firm to Subcontractor Name. The subcontractor acknowledges inclusion of standard clauses around labor standards, apprenticeships, and subcontracting in the agreement. Intermediate subcontractors, if any, are also listed.
The related federal contract opportunity is for network wiring services at the Tunison Aquatics Lab for the Department of the Interior's US Geological Survey Office of Acquisitions and Grants. The solicitation provides high-level details on the required products and services but does not include specifics on pricing, response dates, or other procurement details.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_140G0224R0007_Amd_0001.pdf | ||
| B08_Atch_3_-_Lower_Lab_IT_locations.pdf | ||
| B08_Atch_5_Upper_Lab_Floor_Plan.JPG | JPG image | |
| Sol_140G0224R0007.pdf | ||
| B08_Atch_9_-_Release_of_Claims.pdf | ||
| B08_Atch_2_-_Lower_Floor_Capture.JPG | JPG image | |
| B08_Atch_4_-_Lower_lab_main_switch.jpg | JPG image | |
| B08_Atch_6_Upper_lab_IT_locations.pdf | ||
| B08_Atch_1_SOW_-_Category_6_Ethernet_Upgrades.docx | DOCX document | |
| B08_Atch_7_WD_NY2024106__01052024.pdf | ||
| B08_Atch_8__-_Certified_Payroll_Form.pdf |
Show all 11
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Text version
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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