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DocuSign Envelope ID:F6EBEC99-85A2-493C-BC13-1230D407FDD5 <br /> ox o <br /> Illinois Department Agreement, Amendment or Renewal Overview <br /> o <br /> of Transportation <br /> 03.028.0041 <br /> To From IDOT Reference Number <br /> Cynthia Watters jAundra Williams I IHS-23-0018 <br /> Sub'ect Date <br /> Request For Agreement Approval under$250,000 08/29/22 <br /> AGREEMENT INFORMATION <br /> Office District/CO Bureau <br /> Highways Project Implementation CO Isafety Programs&Engineering <br /> BoBS Contact Person Phone Number Fax Number <br /> Yvonne Sigrist (217)524-3178 (217)782-5634 <br /> Description of Service <br /> State and Community Highway Safety/National Priority Safety Program <br /> Proiect in Relation to <br /> Highway Safety <br /> Description of Action required <br /> Executive Signatures for Grant Execution <br /> ® Initial Legal Review for Grant/IGA/Renewal/Amendment as to Form Completed By Tim Morris <br /> ❑ Financial Disclosures Reviewed as to Form Completed By <br /> Fiscal Years Amount Being Obligated Start Date End Date NOSA/SAIN Number <br /> 2023 1 $90,520.00 10/01/2022 09/30/2023 1 0343-35485 <br /> ADDrODriation Account Code <br /> Compensation Method(Check One): Dollars Match% <br /> ® Estimated ❑ Lump Sum ❑ Schedule of Rates ❑ Flat Rate <br /> Agreement Type(Attach a copy of agreement documents&appropriate approvals) Local <br /> ® UGA ❑ UIGA ❑ IGA ❑ MOU Federal $90,520.00 100% <br /> ❑ IAA ❑ Initial ❑ Renewal ❑ Amendment State <br /> ❑ Other Other <br /> Grantee/Recipient <br /> Name Address <br /> City of Decatur, Illinois 1 Gary K Anderson Plaza <br /> CitV State Zip Code Total Estimated Value of the Agreement <br /> Decatur 162523 $90,520.00 <br /> Contact Person Phone Number Fax Number GATARe # <br /> Steven Hagemeyer (217)424-2721 -- 1 671827 <br /> Email <br /> shagemeyer@decaturil.gov <br /> REMARKS List below or attach an additional sheet Approval Recommended By <br /> A Copy of the Fully Executed Agreement will be sent to Bureau Chief Date <br /> the Program Area and the Grantee. <br /> Please send to: Melanie Turner/Room 303 <br /> Completed 08/28/22 BoBS 2834(Rev.08/26/21) <br />