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�r City of Decatur, Illinois RETURN WITH BID WHEN REQUIRED <br /> j #1 Gary K. Anderson Plaza <br /> Decatur, IL 62523-1196 Minority Business Enterprise (MBE) <br /> Participation Waiver Request <br /> Date: Project Title: <br /> Project Number: <br /> Prime Contractor: <br /> Address: <br /> t I <br /> 1 <br /> Phone: <br /> Contact Person: <br /> Email <br /> We hereby request that the ityi e the M nority Business Enterprise(MBE)10% participation goal on the above <br /> named project for the followi g reas n(s)and affirm that the stated reasons and documents provided are true and <br /> correct and not misleading. a further agree this waiver request does not waive the goal that 18% of the total hours <br /> worked should be performed by minority workers as per City Code Chapter 28,Article 10. <br /> CHECK ALL THAT APPLY. SPECIFIC SUPPORTING DOCUMENTATION MUST BE SUBMITTED AS INDICATED. <br /> ❑ An insufficient number of MBEs responded to our invitation to bid on services or materials. (Attach a list of MBEs <br /> contacted for each work item to be subcontracted along with the dollar amount for each item) <br /> ❑ No subcontracting or purchase of goods, materials or equipment opportunities exist. (Attach explanation) <br /> ❑ The award of subcontract(s)or purchase of goods, materials or equipment is impracticable. (Attach explanation) <br /> ❑ Other—(State reason and attach explanation) <br /> ❑ I meet or exceed the 10%goal for the use of MBEs(detail is provided on the MBE Utilization Statement) <br /> Signature of Prime Contractor Date <br /> FOR OFFICIAL USE ONLY <br /> ❑ APPROVED ❑ DISAPPROVED <br /> The minority participation goals are waived on this project for the following reasons see Article 28-10-7 City Code): <br /> ❑ The project is essential for City operations. <br /> ❑ Emergency circumstances require a waiver. <br /> EI 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 /> ❑ The contractor proposes to meet City MBE goal. No Waiver Required <br /> REVIEWED BY: <br /> Public Works Director Date <br /> 24 <br />