Exhibit K Statement and Acknowledgment SF1413 (Rev 10-23).pdf

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

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

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Fermi Forward Discovery Group, LLC

Kirk Road and Wilson Street

Batavia

Fermi Forward Discovery Group, LLC

Danielle Amico

Procurement Specialist IV

Batavia Road Asphalt Overlay Fermilab Site, 3 miles east of the City of Batavia, Illinois

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, "Batavia Road Asphalt Overlay" dated March 1, 2025, Section 010010 - General Requirements (March 2025), Section 013100 - Environment, Safety and Health Requirements (April 2025), and Section 014100 - Quality Requirements (March 2025) mentioned therein, which the Statement of Work, amendment, and other documents are attached to and hereby made a part of the 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

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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