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City of Decatur, Illinois <br /> #1 Gary K. Anderson Plaza Notification of Change in Participation <br /> • Decatur, IL 62523-1196 <br /> Date: Ma 21, 2015 Project Title: Sunset Levee In-Line Check Valve Installation <br /> Project Number: 2015-13 <br /> Prime Contractor: Burdick Plumbing & Heating Co., Inc. <br /> Address: 1175 North 20th Street <br /> Decatur, Illinois 62521 <br /> Phone: 217-429-2385 <br /> Contact Person: Jeff Burdick <br /> Email: Jeff h„rdickplumb3ng com <br /> If changing from a previously identified subcontractor to another or to change from self-performing to a subcontractor, <br /> complete the followin : <br /> From Name: To Name: <br /> Address: Address: <br /> Phone: Phone: <br /> Status: ❑ MBE ❑ Non-MBE Status: ❑ MBE <br /> ❑ Non-MBE <br /> Contract <br /> Amount: <br /> Will the scope of work change? ❑ Yes E-1No <br /> of Total <br /> Contract: <br /> Describe the scope of work change: 7 <br /> Reason for subcontractor change: <br /> Describe good faith efforts to utilize a MBE: <br /> Signature of Prime Contractor Date <br /> 20 <br />