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Ot'DfC RETURN WITH BID FOR EACH MBE <br /> � City of Decatur, Illinois SUBCONTRACTOR OR SUPPLIER <br /> #1 Gary K. Anderson Plaza <br /> Nc0'- Decatur, IL 62523-1196 Minority Business Enterprise (MBE) <br /> Information Form <br /> Date: 01-14-2026 Project Title: Decatur Electrical Upgrade <br /> Total Contract Value: $185,252.00 Project Number: PUR2025-11 <br /> Section I: Minority Business Enterprise (MBE)Information <br /> Name: • Agile Procurement& Consulting Services, LLC dba Agile Supply Company <br /> Address: 4108 Fieldstone Rd, Suite C <br /> Champaign, IL 61822 <br /> Phone: 217-729-2686 <br /> Contact Person: Bryan Banks <br /> Email: bryan.banks(@acjilesupplycompany.com <br /> Section II: Description of Services or Materials to be Provided _ <br /> Description of Scope of Services Agreed Upon Estimated Amount Estimated of <br /> Total Contract <br /> Electrical Material Supply $25,313.00 13% <br /> This form must be completed and submitted with the bid proposal for each MBE. All MBEs intended for use on this <br /> project shall have an MBE information Form signed by the prime contractor and MBE. If for whatever reason the Prime <br /> Contractor changes or adds en MBE,a Notification of Change in Participation Form and MBE information Form with the <br /> necessary support documentation must be submitted and approved. <br /> The undersigned certifies that the information included herein is true and correct and the MBE subcontractor or material <br /> supplier has agreed to the scope of services described. The undersigned further certifies that this form Is not a Contract <br /> between the City,Prime Contractor or Subcontractor/Material Supplier. <br /> Prime Contractor Signature Print <br /> CL �a <br /> Title )//, Date i —13-2 C. <br /> Minority Business Enterprise Signature Print <br /> Bryan Banks <br /> " e Date <br /> 'President 01-14-2026 <br /> Rev 08/2020 <br />