Laserfiche WebLink
**NOT APPLICABLE <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 h <br />criteria in rules adopted by the political subdivision. / <br />An "affected county" refers to St. Joseph County, Indiana, or the following counties located a /acent 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 usiness: <br />• 5% fora purchase expected by the purchasing agency to be less than $50,0 <br />• 3% for a purchase expected by the purchasing agency to beat least $50, 0 but less than <br />$100, 000. <br />• 1 % fora purchase ex ected by the purchasing agency to beat least $ 0,000. <br />Date: <br />Pursuant to I.C. 36-1-12-22, claims a local Indiana business preference <br />for Project (Project # ) located within the City of South Bend, St. <br />Joseph County, Indiana. <br />❑ The location of the principal place of business is <br />(Address) <br />❑ St. Joseph County, Indiana <br />❑ The following county located adjac/ove. <br />County, Indiana: <br />❑ The majority of the business's payroll for tr to the date of this Bid is to residents of St. Joseph <br />County, Indiana or the adjacent county notThe majority of the business's employeesfprior to the date of this Bid are residents of St. Joseph <br />County, Indiana, or the adjacent countyn <br />If the business is deemed /periodprio <br />e lowest, responsible, responsive bidder, then it shall provide supporting <br />documentation for the 12 moo the date of the Bid of (i) the total payroll amount paid to all employees of the <br />business, and (it) the total aid to employees who are residents of St. Joseph County and the adjacent <br />county noted above. <br />LYING SUPPORTING PAYROLL RECORDS, <br />REDACT ALL SOCIAL SECURITY NUMBERS. <br />Dated this day of 20_. <br />Contractor/Bidder (Firm) <br />Signature of Contractor/Bidder or Its Agent <br />Printed Name and Title <br />