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o�.ne° RETURN WITH BID FOR EACH MBE <br /> City of Decatur, Illinois SUBCONTRACTOR OR SUPPLIER <br /> #1 Gary K. Anderson Plaza <br /> *sr-J <br /> e."-` 4 #1 <br /> IL 62523-1196 Minority Business Enterprise (MBE) <br /> Information Form <br /> Date: 8-25-26 Project Title: City of Decatur Library Boiler Replacement <br /> Total Contract Value: 4. • 5,7.S `'-° Project Number: PUR2026-03 <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: President <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 /> HVAC Equipment& Material Supply IF 5,;7, 00,4 <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 an 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 Si nature Print <br /> / < Joe Kulek <br /> l � <br /> Title Date <br /> President 8-25-26 <br /> Minority Business Enterprise Signature Print <br /> Bryan Banks <br /> itle Date <br /> President 08-25-2026 <br /> Rev 08/2020 <br />