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City of Decatur, IIlinois <br /> .!�r ,' #� �ary �. Anderson Plaza Noti�tcation c►f Change in Participataan <br /> Decatur, IL 62523-1196 <br /> Date; 2l19119 �roject�atte: 2019 Annual Water Main Replacement Project <br /> Project Number: 2419-10 <br /> Prime Contracfor: �UCdICk PIUt1lbiClg & H@a.tltlg GO ItIC <br /> 11�5 N 20th St PQ Box 496 <br /> add�ess: <br /> Decatur 1� �2525 <br /> ��,a�: 217-429-2385 <br /> cor�ta�t��rs�r,: ��red Burdick <br /> Em��i: jaredCburdickplumbing.com <br /> lf changing fram�previously identlfied subcontractor to anather ar to change from sel#•perFarming to a subcontractor, <br /> com lete the followin : <br /> From Nam�: To lJame: <br /> Address: Address: <br /> Pharte: Phons: <br /> Status: ❑ MB� ❑Non�MBE Status: ❑MBE (�Non-MBE <br /> Contract <br /> Amount: <br /> W ii1 the scape of wnrk change? ❑Yes ��o °fa a€Total <br /> Contract: <br /> Describe the scope of wc�rk changc: <br /> Reason for subcantractor change: <br /> Describe good faith efforts to utilize a MBE: <br /> February 20, 2019 <br /> Signa u�e ot Prime Contractor Date <br /> 23 <br />