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' City of Decatur, Illinois RETURN WITH BID <br /> #1 Gary K. Anderson Plaza <br /> Decatur, IL 62523-1196 Minority Business Enterprise (MBE) <br /> Utilization Statement <br /> 1 Date:` j Project Title: 1�41 LID W- Im <br /> i <br /> Total Contract Value: � '1 /�1� Project Number: 2-� --2 <br /> Section I: Prime Contractor Information <br /> Prime Contractor: �1'✓ (,s,�'N (,�J <br /> Address.- <br /> ,- r <br /> Phone: <br /> Contact Person: <br /> Email: - § tvi" I-byyn <br />' Section 11: Selected Subcontractors <br /> MBE or % of Total <br /> Subcontractor dame Non-MBE Amount Contract Scope of Work <br /> W3400 12o2 -Z <br /> r' ZOlt S`DO, <br /> s 9,X- <br /> ,�- ��� / ��� f}� �'• ! 1/11► l�� i <br /> f 7 CIA <br /> I <br /> ab <br /> . � <br /> rr / <br /> Totals � <br /> If more subcontractors are utilized, please copy this form and attach the additional information. <br /> 1 Section III: Purchase of Goods, Materials, or E ui ment _ <br /> Minority Business Enterprise name Amount /Contract f Total Scope of Work <br /> 1 �J <br /> I <br /> Totals _ ---_-- <br /> If more firms were contacted, please copy this form and attach the additional information. <br /> L_— -- <br /> ' Section IV: MBE subcontractors that submitted bids but were not selected <br /> ')n <br />