OMB Control Number: 9000-0014
STATEMENT AND ACKNOWLEDGMENT
Expiration Date: 12/31/2017
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PART I - STATEMENT OF PRIME CONTRACTOR
1. PRIME CONTRACT NO.
2. DATE SUBCONTRACT
3. SUBCONTRACT NUMBER
AWARDED
4. PRIME CONTRACTOR
5. SUBCONTRACTOR
a. NAME
a. NAME
CYE Enterprises, Inc.
b. STREET ADDRESS
b. STREET ADDRESS
76 South Laura Street, Suite 301
c. CITY
d. STATE e. ZIP CODE
c. CITY
d. STATE e. ZIP CODE
Jacksonville
FL
32202
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
CYE Enterprises, Inc.
b. DESCRIPTION OF WORK BY SUBCONTRACTOR
All work to be performed in accordance with the current specifications of Mayport/Fuel Depot
and follow Davis-Bacon Wages
8. PROJECT
9. LOCATION
Mayport/Fuel Depot
10a. NAME OF PERSON SIGNING
11. BY (Signature)
12. DATE SIGNED
Erica Jackson
10b. TITLE OF PERSON SIGNING
President
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
Construction Wage Rate Requirements
(If included in prime contract see Block 6)
Apprentices and Trainees
Payrolls and Basic Records
Compliance with Copeland Act Requirements
Withholding of Funds
Subcontracts (Labor Standards)
Disputes Concerning Labor Standards
Contract Termination - Debarment
Compliance with Construction Wage Rate Requirements
Certification of Eligibility
and Related Regulations
14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY
C
A
B
D
15a. NAME OF PERSON SIGNING
16. BY (Signature)
17. DATE SIGNED
15b. TITLE OF PERSON SIGNING
STANDARD FORM 1413
AUTHORIZED FOR LOCAL REPRODUCTION
(REV. 4/2013)
PREVIOUS EDITION IS NOT USABLE
Prescribed by GSA/FAR (48 CFR) 53.222(e)