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' City of Decatur, illinois RETURN WITH BID FOR EACH <br /> .,��, <br /> #1 Gary K. Anderson Plaza MBE SUBCONTRACTOR <br /> Decatur, IL 62523-1196 MBE Subcontractor Information Form <br /> Date: Project Titte: <br /> Total Contract Value: Project Number: <br /> Section I: MBE Subcontractor Information <br /> Subcontractor: <br /> Address: <br /> Phone: <br /> Confact Person: <br /> Email: <br /> Section II: Estimated Work <br /> Description of Scope of Work Agreed Upon Estimated Amount �stimated%of <br /> Total Contract <br /> This form must be complefed and submitfed with the bid proposa!for each MBE Subcontractor A{I Subcontractors <br /> mtended for use on this project shall have an MBE Subcontractor Information Form signed by the prime confractor and <br /> subcontractor. If for whatever reason the Prime Con#ractor changes or adds a Subcontractor, a Notification of Change in <br /> Participation Form and MBE Subcontractor Information Form with the necessary support documentation must be <br /> submitted and approved. <br /> The undersigned certifies that the information included herein is true and correct and the subcontractar has agreed to perform <br /> the scope of work described. The undersigned further certifies fhat this form is not a Contract between the City, Prime <br /> Contractor or Subcontractor. <br /> Prime Contractor Si nature Print <br /> Titie Date <br /> Subcontractor Signature Print <br /> Title Dafe <br /> -23- <br />