Fillable Standard Form 1413 - Statement And Acknowledgment

OMB Control Number: 9000-0014

STATEMENT AND ACKNOWLEDGMENT

Expiration Date: 12/31/2017

PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average .05 hours per response, including the time for

reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments

regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to U.S. General Services Administration,

Regulatory Secretariat (MVCB)/IC 9000-0014, Office of Governmentwide Acquisition Policy,1800 F Street, NW, Washington, DC 20405.

PART I - STATEMENT OF PRIME CONTRACTOR

1. PRIME CONTRACT NO.

2. DATE SUBCONTRACT

3. SUBCONTRACT NUMBER

AWARDED

4. PRIME CONTRACTOR

5. SUBCONTRACTOR

a. NAME

CYE Enterprises, Inc.

b. STREET ADDRESS

76 South Laura Street, Suite 301

c. CITY

d. STATE e. ZIP CODE

c. CITY

d. STATE e. ZIP CODE

Jacksonville

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

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)

Standard Form 1413 - Statement And Acknowledgment - 2013

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