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r <br /> rCity of Decatur, Illinois <br /> #1 Gary K. Anderson Plaza Notification of Change in Participation <br /> Decatur, IL 62523-1196 <br /> Date: Project Title: <br /> Project Number: <br /> Prime Contractor: <br /> Address: <br /> r <br /> Phone: <br /> Contact Person: <br /> Email: <br /> rIf changing from a previously identified subcontractor to another or to change from self-performing to a subcontractor, <br /> complete the followin : <br /> rFrom Name: To Name: <br /> ' Address: Address: <br /> Phone: Phone: <br /> ' Status: ❑ MBE T—E] Non-MBE Status: ❑ MBE <br /> ❑ 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 /> 1 <br /> Reason for subcontractor change: <br /> r <br /> rDescribe good faith efforts to utilize a MBE: <br /> 1 <br /> ' Signature of Prime Contractor <br /> Date <br /> r 23 <br />