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' Git of Decatur Iilinois <br /> ' RETURN WITH BID WHEN <br /> � #1 Gary K. Anderson Plaza <br /> Decatur, IL 62523-1196 REQUIRED <br /> , Minority Business Enterprise <br /> Participation Waiver Request <br /> ate: �� Project Title: 2019 MANHOLE REHABILITATION PROJECT <br /> Project Number: 2019-14 <br /> rime Contractor: �'�i�'�� ���J�e'' �r Y��'�J'�j+��it1�/� � ZG <br /> �ddress: � <br /> N � . ��� <br /> �hone: ( S' S�> ` ��/� 0��/ ' l7� �S� �� <br /> Contact Person: L�, �^ a <br /> ��., <br /> �mail: �,l/ �F! �/ /-'�'����� L . <br /> We hereby request that the City waive the Minority Business Enterprise(MBE) participation goals on the above named <br /> �roject for the following reason(s). We further affirm that the stated reasons and documents provided are true and <br /> orrect and not misleading. <br /> HECK ALL THAT APPLY. SPECIFIC SUPPORTING DOCUMENTATION MUST BE SUBMITTED AS INDICATED. <br /> � An insufficient number of MBEs responded to our invitation to bid. (Attach a list of MBEs contacted for each work <br /> item to be subcontracted along with the dollar amount for each item) <br /> No subcontracting opportunities exist. (Attach explanation) <br /> ❑ The award of subcontract(s) is impracticable. (Attach explanation) <br /> ❑ Other—(State reason and attach explanation) <br /> � <br /> Si t of Prime Contractor Date <br /> FOR OFFICIAL USE ONLY <br /> ❑ APPROVED ❑ DISAPPROVED <br /> inorit artici ation oals are reduced on this ro'ect for the followin reason s see Article 28-10-7 Cit Code : <br /> ❑ The project is essential for City operations. <br /> ❑ Emergency circumstances require a waiver. <br /> ❑ Evidence of a good faith effort by the contractor. <br /> `� The contractor will self-perform all work and will not subcontract any portion of the project. <br /> REVIEWED BY: <br /> ' , �" � - Z (�'" � <br /> Public Works Director ate <br /> , 2G <br />