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(To he completed only by Contractors/Bidders claiming to he a "local Indiana business"pursuant to 1.C. 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business"refers to arty of the.folloii4ng: <br />(/) A business iMose principal place of business is located in an alketed county. <br />(2) A business thatpays a nrcrjority of its payroll (in dollar l,ohune) to residents oj'cr fected cotorticm <br />(3) A business that employs residents of gfJected counties as a rrrajor•ily of ifs enrploi,ees. <br />(4) A business that makes significant capital inveshnenLs in the affected counties as defined in rules adopted l.y the political <br />subdh4sion, <br />(5) A business that has a substantial posiftve economic rrrrpacl on the affec'fed counties as defined by criteria in rides adopted by <br />the political subdNision. <br />An "gfected coturti," refers to A loseph County, Indiana, or the,following counties located adjacent to St. Joseph Courtly: <br />Islkhart Counoi, Marshall County, S1ar•Ice Cotarly and LaPorte Comity <br />There are the fidlowirrg price preferences for• supplies purchased Aeon? a local Indiana business: <br />• 5%for a purchase expected by the pttrc'hasing agenclr to be less' than $50,000 <br />• 3%. for a pitr•chase expected by the ptrrchasirtg agency to beat least $50, 000 but less than $100, 000, <br />• 1 %for a purchase expected by the purchasing agency to beat least $100,000. <br />Date: M6V L � 3(, ) b 17 <br />Pursuant to I.C. 36-1-12-22, 6,4Arll claims a local Indiana business <br />preference for Project S re -j4 10 f( f t Itst mow -s (Project # ) located within the City of <br />South Bend, St. Joseph County, Indiana. <br />The location of the principal place of business is q 1 q F, � t Sh ti rne� �F fd <br />(Add revs) <br />❑ St. Joseph County, Indiana n// <br />[� The following county located adjacent to St. Joseph County, Indiana: r)Aw'rf= /Q6i/ 4, / <br />FV The majority of the business's payroll for the 12 months prior to the date of this Bid is to residents of St. <br />Joseph County, Indiana or the adjacent county noted above. <br />IS/ The majority of the business's employees for the 12 months prior to the date of this Bid are residents of <br />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, BIDDER SHALL REDACT ALL <br />SOCIAL SECURITY NUMBERS. <br />Dated this 3 { day of &,t k , 20_L_) <br />YC4r"d-1l-6fa d <br />Contractor Bidd - (Firin) ,.... <br />S nature of .ontractor/Bidder or -Its Agent <br />�ee6nn ��rtnr0�l�, 1"�;Nftirh <br />Printed I anic and Thie <br />8 <br />