SF-1413_Statement_and_Acknowledgement_Form_(Subcontracting).pdf
PDF 70 KB Posted
- Attached to
- NEW REQ ROOF REPLACEMENT COTTONWOOD DS
- Solicitation number
- 140A2325R0001
About this file
This is Standard Form 1413 (Statement and Acknowledgment), which is a federal form used to document subcontracting arrangements on prime contracts. The form has two main sections: Part I requires the prime contractor to provide details about the prime contract number, subcontract award date, and information about both the prime contractor and subcontractor, including company names and addresses. Part II is an acknowledgment by the subcontractor that various labor-related clauses are included in the subcontract, such as Contract Work Hours and Safety Standards Act, Construction Wage Rate Requirements, and Compliance with Copeland Act Requirements.
The specific form is related to a Bureau of Indian Education contract (Solicitation #140A2325R0001) for a roof replacement project at Cottonwood DS. The form requires signatures from both the prime contractor and subcontractor representatives, and includes fields to identify any intermediate subcontractors involved in the work. The current version of the form expires on 5/31/2025 and has an OMB Control Number of 9000-0066.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Sol_140A2325R0001_Amd_0001.pdf | ||
| B08_Questions_and_Answers_Log_(1)_0001.xlsx | XLSX spreadsheet | |
| SF25A_Payment_Bond.pdf | ||
| B08_Questions_and_Answers_Log.xlsx | XLSX spreadsheet | |
| WD_AZ20240022_10-04-2024.pdf | ||
| Sol_140A2325R0001.pdf | ||
| SF_24_Bid_Bond.pdf | ||
| A04_SOW.pdf | ||
| Map.docx | DOCX document | |
| SF25_Performance_Bond.pdf |
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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
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.
File details come from the government source that posted it. Updated .