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I� Dl part elC►t Local Public Agency <br /> Of Tiarrspt�rtafion Formal Contract Proposal <br /> COYER SHEET <br /> Proposal Submitted By. <br /> Contractor's Name <br /> Contractor's Address <br /> City State Zip Code <br /> STATE OF ILLINOIS <br /> Local Public Agency Countyr Section Number <br /> City of Decatur IlMacon 122-00224-00-SC <br /> Routes Street/Road Name Type of Funds <br /> 1 Various Motor Fuel Tax and Local Fund <br /> E] Proposal Only ® Proposal and Plans F1 Proposal only,plans are separate <br /> �. Submitted/Approved <br /> For Local Public Agency: <br /> For a County and Road District Project For a Municipal Project <br /> Submitted/Approved Submitted/Approved/Passed <br /> Hi hway Commissioner Signature Date icinature Date <br /> —z-1fld l <br /> ------------------------ <br /> Official Title <br /> Submitted/Approved f•,�, <br /> t County Enoinger/Superintendent of Hi ftwa s Date <br /> Department of franaportatlon <br /> 1Released for bid based on limited review <br /> Re lonal En (neer Sl nature Date <br /> • <br /> Note;Allro osal documents,including Proposal Guaranty Checks or Proposal Bid Bonds,should be stapled together to prevent loss <br /> P P <br /> when bids are processed. <br /> Printed 06/01122 Page 1 of 6 BLR 12200(Rev.01/21/21) <br />