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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: ' Project Title: lredseapee �r ti l o ld e r W% I <br /> ' Project Number: oto !Ll <br /> Prime Contractor: adihe Rech l C d t Ie CCL4"r <br /> 1 1815 N o2anda . <br /> _beAddress: <br /> Ca&r XL toaSOS <br /> ' Phone: (a,-)) q;20 -q.)(,() <br /> Contact Person: Aa n:e Tu r h e l— <br /> ' Email: d-(--u r-" r m <br /> ' If changing from a previously identified subcontractor to another or to change from self-performing to a subcontractor, <br /> 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? ElYes ❑ No of Total <br /> Contract: <br /> Describe the scope of work change: <br /> ' Reason for subcontractor change: <br /> 1 <br /> ' Describe good faith efforts to utilize a MBE: <br /> ' Signature of Prim Date <br /> ' 21 <br />