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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 /> 1 Date: Project Title: <br /> Project Number: <br /> Prime Contractor: <br />' Address: <br /> ' Phone: <br /> Contact Person: <br /> ' Email: <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 /> t Contract <br /> Amount: <br /> Will the scope of work change? ❑Yes ❑ No <br /> ' Describe the scope of work change: <br /> ' Reason for subcontractor change: <br /> ' Describe good faith efforts to utilize an MBE: <br /> ' Signature of Prime Contractor Date <br /> Signature of Prime Contractor Date <br /> ' 22 <br />