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' City of Decatur, Illinois LR.E*'rL'RN WITH BID WHEN REQUIRED <br /> #1 Gary K. Anderson Plaza <br /> Decatur, IL 62523-1196 !Minority Business Enterprise (MBE) <br /> Participation Waiver Request <br /> Project Title: `� rTo� _- <br /> L Project Number: <br /> Prime Contractor: �" Ak&q7l—k 1 G <br /> Address: 1, ---- <br /> 1 Phone: - - 2-1 (q <br /> Contact Person: DIA-JIA Ws <br /> l <br /> Email: A Ad'4 ' - <br /> We hereby request thata City waive the nority Business Enterprise (MBE) 10% participation goal on the above <br /> named project for the following reason(s) and affirm that the stated reasons and documents provided are true and <br /> M correct and not misleading. We further agree this waiver request does not waive the goal that 18% of the total hours <br /> worked should be performed by minority workers as per City Code Chapter 28, Article 10. <br /> CHECK ALL THAT APPLY. SPECIFIC SUPPORTING DOCUMENTATION MUST BE SUBMITTED AS INDICATED. <br /> F ❑ An insufficient number of MBEs responded to our invitation to bid on services or materials. (Attach a list of MBEs <br /> contacted for each work item to be subcontracted along with the dollar amount for each item) <br /> - ❑ No subcontracting or purchase of goods, materials or equipment opportunities exist. (Attach explanation) <br /> ❑ The award of subcontract(s) or purchase of goods, materials or equipment is impracticable. (Attach explanation) --i <br /> Other- (State reason and attach explanation) 'r <br /> El I meet or exceed the 10% goal for the use of MB d to p o d�cf•onRNBE+�Jtifiz tion tement) <br /> ' Sign ur4ofime <br /> Itr Date <br /> TL 6_ FV IZJJ�J OFFICIAL USE ONLY <br /> APPROVED ❑ DISAPPROVED <br /> The minority participation foals are waived on this project for the following reason(s) (see Article 28-10-7 City Code): <br /> ❑ The project is essential for City operations. <br /> ❑ Emergency circumstances require a waiver. -_ -- — — - <br /> Evidence of a ood faith effort bathe contractor. <br /> EJ] The contractor will self-perform all work and will not subcontract any portion of the project.—_ _ _1 <br /> L___❑___�The contractorrp oposes to meet City MBE goal. No Waiver Required <br /> REVIEWED BY' <br /> Public Works Director Date - - - <br /> 22 <br />