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" City of Decatur, Illinois RETURN WITH BID <br /> r � #1 Gary K. Anderson Plaza <br /> .� Decatur, IL 62523-1196 $UbCOt1t1'aCtOr UtI�IZ8t1011 $tat@1'1'1@t1t <br /> � <br /> Date: � ��j � � Project Title: ��i�; "-;�, ,�_ ` � _ _ <br /> � . �z,,�.� L)� �r-;-,��. -�r� �t:�,�: ��, <br /> Project Number: 2(j �J - ��^ <br /> Prime Contractor: �'a �ar� c;Ny , <br /> ��Aucr� D -.1,,;<�. <br /> t--� g� �u�t�rar`o (�v �- <br /> Address: <br /> r_ �� ��j �,�� <br /> E= aiL f�� <br /> Phone: �i-1 - ��16 - ��1�}L'� <br /> Contact Person: Nq d�. �qLL <br /> � <br /> Email: �,�A�; <' ��1 <'_ � ��'��"�� ��:,��.1 i1^, t.1J('�^, <br /> Subcontractors: <br /> Subcontractor Name MBE or Amount % of Total Scope of Work <br /> Non-MBE Contract <br /> � � � <br /> G� . <br /> �,J�,�w�� ����, ���;o �Nc. C�►����� `��aG. I�� ��' i� i������c,�.�c� <br /> Totals <br /> • If more subcontractors are utilized, please copy this form and attach the additional information. <br /> The City of Decatur is committed to promoting minority participation in public works construction projects and in accordance with <br /> Article 28-10 of the City Code, has established the subcontractor utilization goal of 10% Minority Business Enterprises are to be <br /> used in the execution of this project. Prime Contractors have an obligation to make a good faith effort to advance the City's <br /> commitment to increase diversity among the firms working on City construction projects. <br /> This form must be completed and submitted with the bid proposal. All subcontractors intended for use on this project shall <br /> be listed in the columns above; along with the total amount to be paid to the subcontractors; percentage of total contract; and <br /> scope of work. If for whatever reason the Prime Contractor has to utilize a subcontractor not listed above, they must submit a <br /> Notification of Change in Participation with the necessary support documentation. <br /> The undersigned certifies that the information included herein is true and correct; the subcontractors listed above have agreed to <br /> perform the scope of work described. The undersigned further certifies that it has no controlling, dominating, or conflict of <br /> interest in any of the listed subcontractors. <br /> �; --� <br /> ,, <br /> . �� �� �,. � <br /> Signature of Prime Contractor Date <br /> 19 <br />