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Date: <br />(To be completed only by Contractors/Bidders claiming to be a "local Indiana business" pursuant to I.C. 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 <br />adopted by the political subdivision. <br />(5) A business that has a substantial positive economic impact on the affected counties as defined by <br />criteria in rules adopted by the political subdivision. <br />An "affected county" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. <br />Joseph 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 <br />$100,000. <br />• 1 % for a purchase expected by the purchasing agency to beat least $100, 000. <br />3/10/2017 <br />Pursuant to I.C. 36-1-12-22, Chemrite, Inc. claims a local Indiana business preference <br />for Project Water Treatment Chemicals (Project # 2017-2018 ) located within the City of South Bend, St. <br />Joseph County, Indiana. 5202 Belle Wood Court, STE 104 <br />❑ The location of the principal place of business is Buford, GA 30518 <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 of St. Joseph <br />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 residents of St. Joseph <br />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 supporting <br />documentation for the 12 month period prior to the date of the Bid of (i) the total payroll amount paid to all employees of the <br />business, and (ii) the total payroll amount paid to employees who are residents of St. Joseph County and the adjacent <br />county noted above. <br />WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, <br />BIDDER SHALL REDACT ALL SOCIAL SECURITY NUMBERS. <br />Dated this 10th day of March 2017. <br />Chemrte, Inc <br />Cont ac br/Bid r <br />Sig na ur f CoEtor/aiNdVr or Its Agent <br />Frank J. Opp, \President <br />Printed Name and Title <br />