B08_Attachment_7_Subcontractor_Statement_and_Acknowledgment_SF1413-23a.pdf

PDF 687 KB Posted

Attached to
CERC A3 Boiler Upgrade Federal contract opportunity
Solicitation number
140G0126Q0117
Issued by
Department of the Interior US Geological Survey Office of Acquisitions and Grants

About this file

Written by GovTribe AI ·

This is Standard Form 1413 (Rev. 10/2023), a federal contracting template used to document subcontract awards and acknowledge labor standards compliance. The form serves as a statement from the prime contractor and acknowledgment from the subcontractor regarding the flow-down of labor-related contract clauses.

Part I of the form requires the prime contractor to provide identification information for both the prime contract and the subcontract, including contract numbers, award dates, and the names and addresses of both the prime contractor and subcontractor. The form also requires identification of the awarding firm and a description of work to be performed by the subcontractor, along with project name and location. The prime contractor must indicate whether the prime contract contains the Contract Work Hours and Safety Standards Act clause. Part II requires the subcontractor to acknowledge that specific labor standards clauses from the prime contract flow down into the subcontract, including provisions related to overtime compensation, payrolls and basic records, withholding of funds, disputes concerning labor standards, construction wage rate requirements, apprentices and trainees, compliance with the Copeland Act, subcontracts labor standards, contract termination-debarment, and certification of eligibility. The form includes spaces for identifying any intermediate subcontractors and signature blocks for authorized representatives from both the prime contractor and subcontractor. The OMB control number is 9000-0066 with an expiration date of 5/31/2027, and the estimated burden is 0.05 hours to complete.

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Statement And Acknowledgment OMB Control Number: 9000-0066 Expiration Date: 5/31/2027

Part I - Statement Of Prime Contractor

1. Prime Contract Number 2. Date Subcontract

Awarded

3. Subcontract Number

Authorized For Local Reproduction Previous Edition Is Not Usable

STANDARD FORM 1413 (REV. 10/2023)

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

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.

15b. Title Of Person Signing

15a. Name Of Person Signing 16. By (Signature) 17. Date Signed

14. Name(s) Of Any Intermediate Subcontractors, If Any

A C

DB

STANDARD FORM 1413 (REV. 10/2023) BACK

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: 5/31/2027 Part I - Statement Of Prime Contractor

1. Prime Contract Number

2. Date Subcontract Awarded

3. Subcontract Number Authorized For Local Reproduction Previous Edition Is Not Usable

STANDARD FORM 1413 (REV. 10/2023)

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 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.

15b. Title Of Person Signing 15a. Name Of Person Signing

16. By (Signature)

17. Date Signed

14. Name(s) Of Any Intermediate Subcontractors, If Any A C D B

STANDARD FORM 1413 (REV. 10/2023) BACK

1. Enter the Prime Contract Number. :
4a. Enter the Prime Contractor's Name. :
4b. Enter the Prime Contractor's Street Address. :
4c. Enter the Prime Contractor's City.:
7a. Enter the Name of the Awarding Firm.:
10a. Enter the Name of the Person signing this form as the Prime Contractor. :
10b. Enter the Title of the Person signing this form as the Prime Contractor. :
8. Enter the Project name.:
9. Enter the Location. :
7b. Enter a Description of Work completed by the Subcontractor. :
5c. Enter the Subcontractor's City.:
4e. Enter the Prime Contractor's Zone Improvement Plan (ZIP) Code. :
5e. Enter the Subcontractor's Zone Improvement Plan (ZIP) Code. :
4d. Enter the Prime Contractor's State.:
5d. Enter the Subcontractor's State.:
3. Enter the Subcontract Number. :
5a. Enter the Subcontractor's Name.:
5b. Enter the Subcontractor's Street Address.:
2. Enter the Date the Subcontract was Awarded (enter 2 digit month, 2 digit day and 4 digit year).:
12. If you are the Prime Contractor, enter the Date you signed this form (enter 2 digit month, 2 digit day and 4 digit year).:
6. Click here to select, "the prime contract does contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 0
6. Click here to select, "the prime contract does NOT contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 0
16. Sign here if you are the Subcontractor.:
15b. Enter the Title of the Person Signing this form as the Subcontractor. :
15a. Enter the Name of the Person Signing this form as the Subcontractor. :
17. If you are the Subcontractor, enter the Date you signed this form (enter 2 digit month, 2 digit day and 4 digit year).:
14a. Enter the First Name of an Intermediate Subcontractor, If Any. :
14c. Enter the Third Name of an Intermediate Subcontractor, If Any.:
14d. Enter the Fourth Name of an Intermediate Subcontractor, If Any.:
14b. Enter the Second Name of an Intermediate Subcontractor, If Any.:

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