Exhibit K - SF1413.pdf
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- Fire Sprinkler Repair_XGal_IB2A_Lab1_MI50
- Solicitation number
- ISD-381401-RO
About this file
This is Standard Form 1413 (Statement and Acknowledgment), a federal contracting form used to document subcontract awards and confirm compliance with labor standards clauses.
The form documents a subcontract awarded by Fermi Forward Discovery Group, LLC, located at Kirk Road and Wilson Street, Batavia, Illinois 60510, under prime contract number 89243024CSC000002. The form confirms that the prime contract does not contain the Contract Work Hours and Safety Standards Act – Overtime Compensation clause. The subcontractor acknowledges receipt and acceptance of multiple labor standards clauses that are incorporated into the subcontract, including: Contract Work Hours and Safety Standards Act – Overtime Compensation (if applicable); 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; and Certification of Eligibility. The form contains blank fields for the subcontract number, subcontractor identification information, project details, location, work description, intermediate subcontractor names, and signature lines for authorized representatives from both the prime contractor and subcontractor. The OMB control number is 9000-0066 with an expiration date of 5/31/2027.
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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
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
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) |
File details come from the government source that posted it. Updated .