R2016-115 PROJECT MANUAL 2016 MANHOLE REHABILITATION PROJECT (CITY PROJECT 2016-32)

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' ' � Ciry of Decatur, illinois RETURN WITH � : #1 Gary K. Anderson Plaza �` Decatur, (L 62523-1196 BID � ' Subcontractor Utilization Statement ' Date: P�oject Title: 2016 MANHOLE REHABILITATION PROJECT Project Number: 2016-32 II� ' Prime Contractor. � ' Address: � Phone: ' � Contact Person: Email: ' Subcontractors: Subcontractor Name MBE or qmount %of Total Scope of Work ' Non-MBE Contract ' ' , , ' Totals • If more subcontractors are utilized,please copy this form and attach the additional information. � The City of Decatur is committed to promoting minority participation in public works construction projects and in accordance with ' Article 28-10 of the City Code,has established the subcontractor utilization goal of 10% Minority Business Enterprises are to be used in the execution of this project. Prime Contractors have an obligation to make a good faith effort to advance the City's � commitment to increase diversity amang the firms working on City construction projects. ' This form must be completed and submitted with the bid proposal. All subcontractors intended for use an this project shall � be listed in the columns above;along with the total amount to be paid to the subcontractors;percentage of total contract; and scope of work. If for whatever reason the Prime Contractor has to utilize a subcontractor not listed above,they must submit a ' Notification of Change in Participation with the necessary support documentation. � The undersigned cerlifies thaf the information included herein is true and correct;the subcontractors listed above have agreed to perform the scope of work described. The undersigned further certifies that it has no controlling,dominating,or conflict of ' interest in any of the listed subcontractors. � ' Signature of Prime ConVactor Date � �g ,