C04e Attachment 6 SF1413 Subcontractor Acknowlegement 1232SA26Q0785.pdf

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Attached to
Interior Painting for USDA ARS Stuttgart, AR Federal contract opportunity
Solicitation number
1232SA26Q0785
Issued by
Department of Agriculture Agricultural Research Service

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Standard Form 1413 - Statement and Acknowledgment

This is Standard Form 1413 (Revised 10/2023), a federal contracting template prescribed by GSA/FAR (48 CFR 53.222(e)) used to document the relationship between a prime contractor, subcontractor, and any intermediate subcontractors on a federal contract. The form serves two primary functions: Part I requires the prime contractor to formally state that a subcontract was awarded to a specified subcontractor, including identification of the awarding firm and description of work; Part II requires the subcontractor to acknowledge receipt and inclusion of specific labor-related contract clauses in the subcontract agreement.

The form captures essential identifying information for both prime and subcontractors (names, addresses), the prime contract number, subcontract number, and subcontract award date. The critical clauses acknowledged by the subcontractor include Contract Work Hours and Safety Standards Act - Overtime Compensation, Payrolls and Basic Records, Withholding of Funds, Disputes Concerning Labor Standards, Construction Wage Rate Requirements and Related Regulations, Apprentices and Trainees, Compliance with Copeland Act Requirements, Subcontracts (Labor Standards), Contract Termination - Debarment, and Certification of Eligibility. The form also provides space to identify any intermediate subcontractors. Signature blocks are required from authorized representatives of both the prime contractor (Part I) and subcontractor (Part II), with corresponding dates. The OMB control number 9000-0066 is valid through 5/31/2027, with an estimated burden of 0.05 hours for completion.

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Other files for this federal contract opportunity

Other files attached to Interior Painting for USDA ARS Stuttgart, AR, newest first.
File Type Posted
C04b Attachment 2 Wage Determination 1232SA26Q0785.pdf PDF
C04c Attachment 3 ARS_371_CONSTRUCTION PROGRESS 1232SA26Q0785.pdf PDF
C04 SF1442 Combined Synopsis Solicitation 1232SA26Q0785.pdf PDF
C04a Attachment 1 Statement of Work 1232SA26Q0785.pdf PDF
C04d Attachment 4 ARS_372_REQUEST FOR PAYMENT TRANSMITTAL 1232SA26Q0785.pdf PDF

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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.:

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