Exhibit M - SF1413.pdf
Standard Form PDF 139 KB Posted
- Attached to
- Lab A Electric Heat Install
- Solicitation number
- ISD-378581-RO
About this file
This is a Standard Form 1413 (Statement and Acknowledgment), a federal contracting form prescribed by GSA/FAR (48 CFR 53.222(e)) that documents the relationship between a prime contractor and subcontractor under a federal contract.
The prime contract is numbered 89243024CSC000002, with Fermi Forward Discovery Group, LLC (located at Kirk Road and Wilson Street, Batavia, IL 60510) serving as the prime contractor. The form indicates that a subcontract was awarded to an unnamed subcontractor by Fermi Forward Discovery Group, LLC, though specific details regarding the subcontractor's identity, work description, project name, location, subcontract number, and award date are not completed on this template. The prime contract does not contain the Contract Work Hours and Safety Standards Act – Overtime Compensation clause. Part II of the form lists the federal labor standards clauses that are incorporated into the subcontract, including provisions related to payrolls and basic records, withholding of funds, construction wage rate requirements, apprentices and trainees, Copeland Act compliance, labor standards disputes, contract termination and debarment, and certification of eligibility. The form requires signature acknowledgment from both the prime contractor and subcontractor representatives. This is a blank or partially completed template form with OMB Control Number 9000-0066 (expiration date 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 .