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' <br /> � City of Decatur, Illinois <br /> ' #1 Gary K. Anderson Plaza Notification of Change in Participation <br /> ���� Decatur, IL 62523-1196 <br /> ' Date: June 5, 2019 Project Title: 2019 Trenchless Long Lining Repairs <br /> Project Number: 2019-28 <br /> ' Prime Contractor: Insituform Technologies USA, LLC <br /> 17988 Edison Avenue, Cheste�eld, MO 63005 <br /> , Address: <br /> � Phone: 636-530-8000 <br /> Contact Person: Janet Hass, Contracting & Attesting Officer <br /> ' Emait: jhass@aegion.com <br /> If changing from a previously identified subcontractor to another or to change from self-perForming to a subcontractor, <br /> ' complete the following: <br /> From Name: To Name: <br /> , <br /> Address: Address: <br /> 1 Phone: Phone: <br /> , Status: ❑ MBE ❑ Non-MBE Status: ❑ MBE ❑ Non-MBE <br /> Contract <br /> Amount: <br /> , Will the scope of work change? ❑Yes ❑ No % of Total <br /> Contract: <br /> Describe the scope of work change: <br /> , <br /> ' Reason for subcontractor change: <br /> , <br /> ' Describe good faith efforts to utilize a MBE: <br /> ' <br /> ' June 5, 2019 <br /> Signature of Prime Contractor Date <br /> J et Hass, Contracting & Attesting O�cer <br /> ' 21 <br />