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Exhibit B <br /> Illinois Department <br /> of Transportation Engineering Payment Report <br /> Prime Consultant <br /> Name Massie Massie &Associates <br /> Address 1210 S.5 , Springfield, IL <br /> Telephone 217.544.3210 <br /> TIN Number <br /> Project Information <br /> Local Agency City of Decatur, IL <br /> Section Number TE-OOD7(040) <br /> Project Number 10-00012-00-MS <br /> Job Number P-97-011-11 <br /> This form is to verify the amount paid to the Sub-consultant on the above captioned contract. Under penalty of law for <br /> perjury or falsification, the undersigned certifies that work was executed by the Sub-consultant for the amount listed below. <br /> Sub-Consultant Name TIN Number Actual Payment <br /> from Prime <br /> Sub-Consultant Total: <br /> Prime Consultant Total: <br /> Total for all Work <br /> Completed: <br /> Signature and title of Prime Consultant Date <br /> Note: The Department of Transportation is requesting disclosure of information that is necessary to accomplish the statutory <br /> purpose as outlined under state and federal law. Disclosure of this information is REQUIRED and shall be deemed as <br /> concurrinq with the payment amount specified above. <br /> Page 7 of 7 BLR 05610(Rev. 9/06) <br /> Printed on 3/15/2012 10:54:35 AM <br />