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(To be completed only by Contr•actor•sBidders clahning to be a "local Indiana bu,sirre>ss "pur•.s'rrrrrrt to 1. C. 36..1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana busirres.s" refer,, to any oj'the follmving: <br />(1) A business whose principal place of business is located in an g1kcted county. <br />(2) A business that pays a rnajor•ih, gJ'its prri,roll (in dollar volume) to residents o1'af e(ed cotwicv, <br />(3) A business that employs residents gf •afrec•ted counties as a rncjor•ity of'its ernplc ivees. <br />(4) A business that rnalces• significant capital investments in the al%ected counties as deJirx rl in rules rrrlrrpt< r! bs tlrc political <br />subdivision, <br />(5) A business that has a substantial positire economic intpact on the ajlected caurrtics its clejiurrl !,s criteria iu rrrlcs uclnlrted h� <br />the political subdivision. <br />An "affected county"reler•s to St. Joseph County, Indiana, or the following counties located adjacent to St..1os•eph Counts•: <br />Elkhart County, Marshall County. Starke County and LaPorte County <br />There are the following price preJererares.fnr ,supplies purchased from a local Indiana business: <br />• 5%for a purchase expected b'r the purchasing agency to be less than $50,000 <br />3 % for a pur•c•hase expected by the purchasing agency to beat least 350,000 bill less thctrr Sl oo, 000. <br />• I % or a purchase expected br the purchasing a enct, to be at least $]00,000, <br />Date; 0 rJ <br />Pursuant to I.C, 36-1Admt <br />2, claims a local Indiana business <br />preference for Project e (Project # 1 located within the City of <br />South Bend, St. Joseph County, Indiana, <br />The location of the principal place of business is 4 AC W C��% /%' F�,✓ <br />A14h I'll) <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 laid is to residents of St. <br />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 arc 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 l.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 />WHENSUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACT ALL <br />SOCIAL SECU IIfTYNUMBERS. <br />Dated this day of , 20 / <br />Contractor/ icArign) <br />---. <br />%r <br />Signat re of r cart r iddcr nr Its Ag lit <br />Printed Natnc and Title <br />