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(To be completed only by Contractors/Bidders claiming to be a "local Indiana business" pursuant to I.C. <br />36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business" refers to any of the following: <br />(1) A business whose principal place of business is located in an affected county. <br />(2) A business that pays a majority of its payroll (in dollar volume) to residents of affected counties. <br />(3) A business that employs residents of affected counties as a majority of its employees. <br />(4) A business that makes significant capital investments in the affected counties as defined in rules adopted by the <br />political subdivision. <br />(5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rules <br />adopted by the political subdivision. <br />An "affected county' refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Joseph <br />County: Elkhart County, Marshall County, Starke County and LaPorte County <br />There are the following price preferences for supplies purchased from a local Indiana business: <br />• 5% for a purchase expected by the purchasing agency to be less than $50,000 <br />• 3% for a purchase expected by the purchasing agency to beat least $50,000 but less than $100, 000. <br />• 1916 for a purchase expected by the purchasinq aqencv to be at least $100.000. <br />Date: <br />Pursuant to I.C. 36-1-12-22, S—>kerw •� f{7 ��,}E , claims a local Indiana <br />business preference for Project E fh `� mot- V ~ f (Project # //(y /J& 1 <br />located within the City of South Be , S11. JosepCounty, Indiana. <br />❑ The location of the principal place of business is 4- <br />(Address) <br />❑ St. Joseph County, Indiana <br />❑ The following county located adjacent to St. Joseph County, Indiana: <br />❑ The majority of the business's payroll for the 12 months prior to the date of this Bid is to residents <br />of St. Joseph County, Indiana or the adjacent county noted above. <br />❑ The majority of the business's employees for the 12 months prior to the date of this Bid are <br />residents of St. Joseph County, Indiana, or the adjacent county noted above. <br />If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shall provide <br />supporting documentation for the 12 month period prior to the date of the Bid of (i) the total payroll <br />amount paid to all employees of the business, and (ii) the total payroll amount paid to employees who are <br />residents of St. Joseph County and the adjacent county noted above. <br />WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, <br />BIDDER SHALL REDACT ALL SOCIAL SECURITY NUMBERS <br />Dated this (�� day of 9 ` , 20/T <br />Contractor/Bidder (Firm) <br />i, � <br />ar or Its <br />