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F°` ,, City of Decatur, Illinois <br /> v),,14- .,-, #1 Gary K. Anderson Plaza Notification of Change in Participation <br /> '44No�s. Decatur, IL 62523-1196 <br /> Date: Project Title: <br /> Project Number: <br /> Prime Contractor: <br /> Address: 1 <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 <br /> to 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 /> Contract <br /> Amount: <br /> Will the scope of work change? 0 Yes 0 No <br /> Describe the scope of work change: <br /> \ <br /> Reason for subcontractor change: <br /> Describe good faith efforts to utilize an MBE: <br /> • \ <br /> Signature of Prime Contractor Date <br /> Rev 08/2020 <br />