Laserfiche WebLink
Exhibit B <br /> Illinois Department <br /> of Transportation Engineering Payment Report <br /> (Submit with Final Invoice ) <br /> Prime Consultant <br /> Name AECOM Technical Services Inc <br /> Address 345 E Ash Ave Decatur, IL 62526 <br /> Telephone 217-775-6065 <br /> TIN Number 95-2661922 <br /> Project Information <br /> Local Agency City of Decatur <br /> Section Number 09-00933-01-BR <br /> Project Number 6WGY(165) <br /> Job Number D97-009-19 <br /> This form is to verify the amount paid to the Sub-consultant on the above captioned contract. Under penalty of law for <br /> perjury or falsification, the undersigned certifies that work was executed by the Sub-consultant for the amount listed below. <br /> Sub-Consultant Name TIN Number Actual Payment <br /> from Prime <br /> Quigg Engineering, Inc 20-4818431 <br /> Kaskaskia Engineering Group, LLC 20-5080586 <br /> WHKS 42-0943038 <br /> Sub-Consultant Total: <br /> Prime Consultant Total: <br /> Total for all Work <br /> Completed: <br /> Signature and title of Prime Consultant Date <br /> Note: The Department of Transportation is requesting disclosure of information that is necessary to accomplish the statutory <br /> purpose as outlined under state and federal law. Disclosure of this information is REQUIRED and shall be deemed as <br /> concurring with the payment amount specified above. <br /> For information about IDOTs collection and use of confidential information review the department's Identity Protection Policy. <br /> Page 7 of 8 DLR 05610(Rev.05/31/19) <br /> Printed on 8/28/2020 11:48:36 AM <br />