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' ---� <br /> ,f�� , City of Decatur, Illinois RETURN WITH <br /> ' � #1 Gary K. Anderson Plaza <br /> �� Decatur, IL 62523-1196 BID <br /> ' Subcontractor Utilization Statement <br /> ' �ate: September 19, 2016 Project Title: 2016 MANHOLE REHABILITATION PROJECT <br /> Pro�ect Number: 2016-32 <br /> , Prime Contractor: Culy Contracting, Inc. <br /> 5 Industrial Park Drive <br /> ' Address: <br /> Winchester, IN 47394 <br /> Phone: 765-584-8509 <br /> ' Contact Person: Ben PrICe <br /> Email: benp�a culycontacting.com <br /> ' Subcontractors: <br /> Subcontractor Name MBE or Amount % of Total Scope of Work <br /> , Non-MBE Contract <br /> N/A - None exist <br /> ' ' <br /> t <br /> t <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 qroposal. 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 /> t 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 /> l ,iC.��.,__ � 1/ �'L ' September 22, 2016 <br /> ' Signatu of Prim ctor Date <br /> .-�`J 18 <br /> ' <br />