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' <br /> � City of Decatur, Illinois <br /> ' � #1 Gary K. Anderson Plaza Notification of Change in Participation <br /> Decatur, IL 62523-1196 <br /> � Date: Project Title: <br /> ' Project Number: <br /> Prime Contractor: <br /> ' Address: <br /> ' Phone: <br /> � Contact Person: <br /> Email: <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 ❑ Non-MBE <br /> Contract <br /> Amount: <br /> , Will the scope of work change? ❑ Yes � No % of Total <br /> Contract: <br /> Describe the scope of work change: <br /> ' <br /> � Reason for subcontractor change: <br /> � <br /> � Describe good faith efforts to utilize a MBE: <br /> ' <br /> ' Signature of Prime Contractor Date <br /> , 21 <br />