Exhibit J SF1413-fill-ins.pdf
Standard Form PDF 127 KB Posted
- Attached to
- General Construction Pool IDIQ
- Solicitation number
- ISD_368518_DA
About this file
This is a Standard Form 1413, a Statement and Acknowledgment document for a subcontract between Fermi Forward Discovery Group, LLC (prime contractor) for a General Contracting IDIQ Pool project located at Fermilab Site, 3 miles east of Batavia, Illinois. The subcontract requires furnishing all labor, materials, transportation, overhead, insurance, bonding costs, safety oversight, quality control, supervision, and equipment to perform general construction services, as detailed in the Statement of Work dated October 7, 2025. The document includes sections on general requirements and environment, safety, and health requirements from March and April 2025, respectively. The prime contract number is 89243024CSC000002, and the project involves comprehensive construction services with specific compliance requirements related to labor standards, wage rates, and contract clauses.
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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
Authorized For Local Reproduction Previous Edition Is Not Usable
STANDARD FORM 1413 (REV. 10/2023)
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
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
89243024CSC000002
Fermi Forward Discovery Group, LLC
Kirk Road and Wilson Street
Batavia
Fermi Forward Discovery Group, LLC
Danielle Amico
Procurement Specialist IV
General Contracting IDIQ Pool Fermilab Site, 3 miles east of the City of Batavia, Illinois
b. Description Of Work By Subcontractor The Subcontractor shall furnish all labor, materials, transportation, overhead, insurance, bonding costs, safety oversight, quality control oversight, supervision, and equipment necessary to perform the work described in the Statement of Work entitled, “General Construction Services” dated October 7, 2025, Section 010010 - General Requirements (March 2025), Section 013100 -Environment, Safety, and Health Requirements (April 2025) mentioned therein, which the Statement of Work, amendment, and other documents are attached to and hereby made a part of this Subcontract.
60510IL
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.
15b. Title Of Person Signing
15a. Name Of Person Signing 16. By (Signature) 17. Date Signed
14. Name(s) Of Any Intermediate Subcontractors, If Any
A C
DB
STANDARD FORM 1413 (REV. 10/2023) BACK
| 2 Date Subcontract Awarded: |
| 3 Subcontract Number: |
| 5 Subcontractor: |
| a Name: |
| b Street Address: |
| c City: |
| d State: |
| e ZIP Code: |
| 14 Names Of Any Intermediate Subcontractors If Any: |
| C: |
| B: |
| D: |
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