EXHIBIT_12_SF1413-23a.pdf
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- Attached to
- PIP-II Main Ring Crossing Construction
- Solicitation number
- 366946_MR
About this file
This is a Standard Form 1413 (Statement and Acknowledgment) documenting a subcontract award under prime contract number 89243024CSC000002. The prime contractor is Fermi Forward Discovery Group, LLC, located at Kirk Road and Wilson Street, Batavia, Illinois 60510. The subcontractor information fields remain blank in this document, indicating this is a template or incomplete form awaiting subcontractor details.
The subcontract pertains to the PIP-II CPB HX and Pump project (Project No. 4-3-3G) located at Fermilab Site, 3 miles east of Batavia, DuPage County, Illinois. The scope of work includes all labor, equipment, transportation, overhead, bonding costs, insurance, safety oversight, quality control oversight, and supervision necessary to mobilize, procure, deliver, and install the specified equipment. The prime contract contains the Contract Work Hours and Safety Standards Act—Overtime Compensation clause. The subcontract incorporates multiple federal labor standards clauses including payroll and basic records requirements, construction wage rate compliance, Copeland Act requirements, apprenticeship and trainee provisions, and debarment certification of eligibility. The form was signed by Michele Reynolds, Procurement Manager for the prime contractor. No intermediate subcontractors are identified in this submission.
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Text version
Part I - Statement Of Prime Contractor
1. Prime Contract Number
89243024CSC000002
2. Date Subcontract Awarded 3. Subcontract Number
4. Prime Contractor 5. Subcontractor
a. Name Fermi Forward Discovery Group, LLC
a. Name
b. Street Address Kirk Road and Wilson Street
b. Street Address
c. City Batavia
d. State
IL
e. ZIP Code 60510
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 Fermi Forward Discovery Group, LLC
b. Description Of Work By Subcontractor The scope of work consists of all labor, equipment, transportation, overhead, bonding costs, insurance, safety oversight, QC oversight and supervision as required to ensure, mobilize, procure, deliver and install the scope of work known as the PIP-II CPB HX and Pump (Project No. 4-3-3G).
8. Project
PIP-II CPB HX AND PUMP
9. Location
Fermilab Site, 3 miles East of City of Batavia, DuPage
10a. Name of Person Signing Michele Reynolds
11. By (Signature) 12. Date Signed
10b. Title of Person Signing Procurement Manager
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
Authorized For Local Reproduction.
Previous Edition Is Not Usable
STANDARD FORM 1413 (REV. 10/2023)
Prescribed by GSA/FAR (48 CFR) 53.222(e)
Statement And Acknowledgment OMB Control Number: 9000-0066 Expiration Date: 5/31/2027
14. Name(s) Of Any Intermediate Subcontractors, If Any
A C
B D
15a. Name of Person Signing 16. By (Signature) 17. Date Signed
15b. Title of Person Signing
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.
STANDARD FORM 1413 (REV. 10/2023) BACK
| Part I - Statement Of Prime Contractor |
| Part II - Acknowledgment Of Subcontractor |
| STANDARD FORM 1413 (REV. 10/2023) |
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