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I <br /> RETURN WITH BID FOR EACH MBE <br /> City of Decatur, Illinois SU::0._. BCONTRACTOR Gary K. Anderson Plaza OR SUPPLIER <br /> r,, Decatur, IL 62523-1196 Minority Business Enterprise (MBE) <br /> Information Form <br /> ISOUTH TAYLORVILLE ROAD WATER MAIN <br /> Date: 3/5/26 Project Title: - REPLACEMENT PROJECT <br /> ITotal Contract Value: - Project Number: 2024_16 <br /> Section I: Minority Business Enterprise (MBE)Information <br /> IName: JP Excavating & Trucking Inc <br /> 410 e 9th st, Danville, IL 61832 <br /> Address: <br /> I <br /> Phone: 217-304-5431 <br /> Contact Person: Jamie Powell <br /> IIEmail: Jamie.jpinc@att.net <br /> Section II: Description of Services or Materials to be Provided <br /> I Description of Scope of Services Agreed Upon Estimated Amount Estimated %of <br /> Total Contract <br /> Trucking Base Bid $133,110.00 4.9% <br /> ITrucking Alt 1 $87,450.00 <br /> ITrucking Alt 2 $73,210.00 <br /> I 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 an MBE, a Notification of Change in Participation Form and MBE Information Form with the <br /> Inecessary 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 supplier <br /> has agreed to the scope of services described. The undersigned further certifies that this form is not a Contract between the <br /> I City, Prime Contractor or Subcontractor/Material Supplier. <br /> Prim ontractor Signature Print <br /> ' 4g <br /> Justin Weidner <br /> Title Date <br /> President 3/5/26 <br /> I <br /> MinorityBusine nterprise Signature Print <br /> Jamie Powell <br /> I <br /> .16.3)-(11-11)Title Date <br /> I <br /> President 03-04-2026 <br /> I <br /> 31 <br />