B08_A4__SF1413_Subcontractor_Statement_and_Acknowledgement.pdf

PDF 768 KB Posted Feb 11, 2026

Attached to: EMERGENCY STROBE TOWERS - HINU
Solicitation number: 140A2326Q0047
Issued by: Department of the Interior Bureau of Indian Affairs Bureau of Indian Education

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Written by GovTribe AI · Feb 11, 2026

This is Standard Form 1413, a federal Statement and Acknowledgment form prescribed by the General Services Administration under FAR 48 CFR 53.222(e). The form is a template used to document the relationship between a prime contractor and subcontractor on federal contracts, establishing compliance with labor standards requirements.

Part I requires the prime contractor to document subcontract information, including the prime contract number, subcontract award date and number, names and addresses of both the prime contractor and subcontractor, the awarding firm, and a description of work to be performed by the subcontractor. The prime contractor must also indicate whether the prime contract contains the Contract Work Hours and Safety Standards Act - Overtime Compensation clause. Part II requires the subcontractor to acknowledge receipt and inclusion of specific labor standards clauses in the subcontract, including provisions related to contract work hours, safety standards, payroll records, wage rate requirements for construction work, apprentices and trainees, Copeland Act compliance, and contract termination and debarment provisions. The form requires signature and date authorization from both the prime contractor and subcontractor representatives, and provides space to list any intermediate subcontractors. The OMB Control Number 9000-0066 is valid through May 31, 2025, with an estimated completion time of 0.05 hours.

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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:

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

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.

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: 5/31/2025

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

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 RecordsWithholding of FundsDisputes Concerning Labor StandardsCompliance 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.

1. PRIME CONTRACT NUMBER:

4A. NAME:

4B. STREET ADDRESS:

4C. CITY:

7A. NAME OF AWARDING FIRM:

10A. NAME OF PERSON SIGNING:

15A. NAME OF PERSON SIGNING:

15B. TITLE OF PERSON SIGNING:

10B. TITLE OF PERSON SIGNING:

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line A.:

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line D.:

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line C.:

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line B.:

8. PROJECT:

9. LOCATION:

7B. DESCRIPTION OF WORK BY SUBCONTRACTOR:

5C. CITY:

4E. ZIP CODE:

5E. ZIP CODE:

4D. STATE:

5D. STATE:

3. SUBCONTRACT NUMBER:

5A. NAME:

5B. STREET ADDRESS:

2. DATE SUBCONTRACT AWARDED. Enter 2 digit month, 2 digit day and 4 digit year.:

12. DATE SIGNED. Enter 2 digit month, 2 digit day and 4 digit year.:

17. DATE SIGNED. Enter 2 digit month, 2 digit day and 4 digit year.:

6. The prime contract does contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 0

6. The prime contract does not contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 0

Sign here if you are the Subcontractor.:

File details come from the government source that posted it. Updated Feb 11, 2026.