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' <br /> I � ' City of Decatur, Illinois RETURN WITH <br /> ' � #1 Gary K. Anderson Plaza <br /> Decatur, IL 62523-1196 BID <br /> ' Subcontractor Utilization Statement <br /> Date: �, �' I�� Project Title: �� �� • ��,����,�y ��;��,,�<j-� ;�--��� ���� <br /> ' Project Number: U� ,� <br /> Prime Contractor: �✓����'Q-f� ��--u�C�—���^ �_ <br /> i ` � <br /> Address: � '�� ^ ��� <br /> � ���:.�-�;.� �� �� �`���.� <br /> Phone: `�—� — � � <br /> ' Contact Person: C�.�-�- u L����—`'�L <br /> Email: C:�.����,�1 �-��� ---' t/�lC`�\ ,�.��✓� <br /> � <br /> Subcontractors: <br /> Subcontractor Name MBE or Amount %of Total Scope of Work <br /> ' Non-MBE Contract <br /> � <br /> � ,. �� �'1'�� � � l`, � �'- ��► � .,���..,, <br /> ' \ <br /> , <br /> ' <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 a of the li ted su_ ontr tors. <br /> ��_�-4--� � <br /> 'gnature of Prime Contractor Date <br /> ' <br /> 21 <br />