Rev Exhibit J Statement and Acknowledgment (SF1413-23)_FFDG.pdf

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Attached to
Fire House Generator and ATS Replacement
Solicitation number
ISD_363232_DA
Issued by

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This is a Standard Form 1413 (Statement and Acknowledgment) for a subcontract under prime contract number 89243024CSC000002. The form documents a subcontract awarded by Fermi Forward Discovery Group, LLC (prime contractor) for the Fire Department Generator and ATS Replacement project located at the Fermilab Site, 3 miles east of the City of Batavia, Kane County, Illinois.

The subcontractor's scope includes furnishing all labor, materials, transportation, overhead, insurance, bonding costs, safety oversight, quality control oversight, supervision, and equipment necessary to perform work described in the Statement of Work for Fire Department Generator Replacement. The prime contract contains the Contract Work Hours and Safety Standards Act clause, and the subcontractor must comply with various labor standards including Construction Wage Rate Requirements, Apprentices and Trainees requirements, and Copeland Act Requirements. The prime contractor's representative signing the form is Danielle Amico, serving as Procurement Specialist IV.

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Amendment 02 to RFP 363232.pdf PDF
Rev Exhibit C updated 013100_ESH_Requirements_FermiForward.pdf PDF
Rev Exhibit H Performance Bond FL-40_FFDG.pdf PDF
Rev Exhibit L SARC_Subcontractor Annual RepsCerts Rev 4_FFDG.pdf PDF
Rev Exhibit B updated 010010_General_Requirements_3_2022 FermiForward.pdf PDF
Rev Exhibit D General Terms and Conditions for Construction (01-2025)_FFDG.pdf PDF
Rev Exhibit K Proposal Certifications Form PUR-466_FFDG.pdf PDF
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Rev Exhibit E Construction Insurance Requirements (01-2025)_FFDG.pdf PDF
Rev Exhibit F Bid Bond FL-41_FFDG.pdf PDF
Rev Exhibit G Payment Bond FL-42_FFDG.pdf PDF
Amendment 01 to RFP 363232.pdf PDF
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Exhibit G Payment Bond FL-42 (Rev 12.22).pdf PDF
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Exhibit H Performance Bond FL-40 (Rev 12.22).pdf PDF
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Exhibit E Construction Insurance Requirements 2024.pdf PDF
Exhibit J Statement and Acknowledgment (Standard Form 1413) (Rev 42013).pdf PDF
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1.0 Request for Proposal_ISD_363232_DA.pdf PDF
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Exhibit F Bid Bond FL-41 (Rev 12.22).pdf PDF
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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

15b. TITLE OF PERSON SIGNING

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1413 (REV. 4/2013)

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

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY

A C

B D

15a. NAME OF PERSON SIGNING 16. BY (Signature) 17. DATE SIGNED

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.

1.6 Presentation Agent PDFlib 3.02 (C++/Win32) D:20050617125503-04'00' D:20080212101247-05'00' Presentation Agent Standard Form 1413 - Statement and Acknowledgment

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

15b. TITLE OF PERSON SIGNING

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1413 (REV. 4/2013)

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 RecordsWithholding of FundsDisputes Concerning Labor StandardsCompliance 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

14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY

A C B D 15a. NAME OF PERSON SIGNING

16. BY (Signature)

17. DATE SIGNED

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.

1. PRIME CONTRACT NUMBER: 89243024CSC000002
4A. NAME: Fermi Forward Discovery Group, LLC
4B. STREET ADDRESS: Kirk Road and Wilson Street
4C. CITY: Batavia
7A. NAME OF AWARDING FIRM: Fermi Forward Discovery Group, LLC
10A. NAME OF PERSON SIGNING: Danielle Amico
15A. NAME OF PERSON SIGNING:
15B. TITLE OF PERSON SIGNING:
10B. TITLE OF PERSON SIGNING: Procurement Specialist IV
14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line A.:
14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line D.:
14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line C.:
14. NAME(S) OF ANY INTERMEDIATE SUBCONTRACTORS, IF ANY. Line B.:
8. PROJECT: Fire Department Generator and ATS Replacement
9. LOCATION: Fermilab Site, 3 miles east of the City of Batavia, Kane County, Illinois
7B. 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, “Statement of Work - Fire Dept Generator Replacement," Section 010010 - General Requirement (March 2022), Section 013100 - Environment, Safety, and Health Requirements (March 2022) mentioned therein, which the Statement of Work, amendment, and other documents are attached to and hereby made a part of this Subcontract.
5C. CITY:
4E. ZIP CODE: 60510
5E. ZIP CODE:
4D. STATE: IL
5D. STATE:
3. SUBCONTRACT NUMBER:
5A. NAME:
5B. STREET ADDRESS:
2. DATE SUBCONTRACT AWARDED. Enter 2 digit month, 2 digit day and 4 digit year.:
12. DATE SIGNED. Enter 2 digit month, 2 digit day and 4 digit year.:
17. DATE SIGNED. Enter 2 digit month, 2 digit day and 4 digit year.:
6. The prime contract does contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 1
6. The prime contract does not contain the clause entitled "Contract Work Hours and Safety Standards Act -- Overtime Compensation.": 0
Sign here if you are the Subcontractor.:

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