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.k. City of Decatur, Illinois RETURN WITH BID FOR EACH <br /> #1 Gary K. Anderson Plaza <br /> Decatur, IL 62523-1196 MBE SUBCONTRACTOR <br /> MSE Subcontractor Information Form <br /> Date: 2/09/2022 Project Title: 2022 Valve + Hydrant Replacment Project <br /> --TTotal Contract Value: T $311 , 222 .00 Project Number: 2022-23 <br /> Section I: MBE Subcontractor Information <br /> Subcontractor: Marenco Enterprises <br /> ' <br /> Address: 3490 Leghorn Rd. <br /> Clinton, IL 61727 <br /> ' Phone: (217) 693-2484 <br /> Contact Person: Mirna Willoughby <br /> rEmail: mirna.marenco.ent@gmail.com <br /> Section 11: Estimated Work <br /> Description of Scope of Work Agreed Upon Estimated Amount Estimated% of <br /> Total Contract <br /> ' Trucking - Spoils + Rock <br /> Rough/Final Grading + Seeding $67,000.00 22% <br /> Material Supplier <br /> This form must be completed and submitted with the bid proposal for each MBE Subcontractor. All Subcontractors <br /> intended for use on this project shall have an MBE Subcontractor Information Form signed by the prime contractor and <br /> subcontractor. If for whatever reason the Prime Contractor changes or adds a Subcontractor, a Notification of Change in <br /> Participation Form and MBE Subcontractor Information Form with the necessary support documentation must be submitted <br /> and approved. <br /> The undersigned certifies that the information included herein is true and correct and the subcontractor has agreed to perform <br /> the scope of work described. The undersigned further certifies that this form is not a Contract between the City, Prime <br /> Contractor or Subcontractor. <br /> lime ontractor Si ure Print <br /> Jared Burdick <br /> ' Title Date <br /> Project Manager 2/02/2022 <br /> Subcontractor Signature Print <br /> z)-y7i"U14�—Ze-'/� Mirna Willoughby <br /> Title Date <br /> President 2/02/2022 <br /> ' 24 <br />