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City of Decatur, Illinois <br /> #1 Gary K. Anderson Plaza Notification of Change in Participation <br /> Decatur, IL 62523-1196 <br /> Date: February 16, 2022 Project Title: 2022 Trenchless Long Lining Repairs <br /> Project Number: 2022-28 <br /> Prime Contractor: Insituform Technologies USA, LLC <br /> Address: <br /> 17988 Edison Avenue, Chesterfield, MO 63005 <br /> _ __.... <br /> Phone: 636-530-8000 <br /> Contact Person: Janet Hass, Contracting & Attesting Officer <br /> Email: jhass@aegion.com <br /> If changing from a previously identified subcontractor/material supplier to another or to change from self-performing to <br /> a subcontractor, complete the following: <br /> From Name: To Name: <br /> Address: Address: <br /> Phone: Phone: <br /> Status: ❑ MBE ❑ Non-MBE Status: ❑ MBE ❑ Non-MBE <br /> Contract <br /> Amount: <br /> Will the scope of work change? El Yes ❑ No <br /> Describe the scope of work change: <br /> Reason for subcontractor change: <br /> Describe good faith efforts to utilize an MBE: <br /> Janet Hass February 16, 2022 <br /> Signature of Prime Contractor _T Date <br /> Jana Lause_ February 16, 2022 <br /> ->' Signature of Prime Contractor Date <br /> .. ''4 <br />