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� City of Decatur, Illinois <br /> � �� #1 Gary K. Anderson Plaza Nvtification of Change in Participation <br /> Decatur, IL 62523-1�9fi <br /> Date: Praject Title: <br /> Project Number: <br /> Prime Contractor. <br /> Address: <br /> Phone: <br /> Contact Person: <br /> Email: <br /> tf changing from a previousMy identified subcontractor to anofher or to change from self-perfarming to a subcontractor, <br /> complete the following: <br /> Fram Rlame: To Name: <br /> Address; Address: <br /> Phane: Phone: <br /> Status: ❑MBE ❑Non-MBE Status: ❑ MBE ❑Non-MBE <br /> Contract <br /> Amount: <br /> Wil!the scope of work change? ❑Yes � �� %of Total <br /> ContracE: <br /> Describe the scope of work change: <br /> Reasan far subcan#ractor change: <br /> Describe gnod faith effcarts to utilize a MBE: <br /> Signatu�e of Prime Confractar C}ate <br /> 21 <br />