Laserfiche WebLink
(To be completed only by Contractors/Bidders claiming to be a `local Indiana hrrsiuess"parr;srrant to 1.C. 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business" rq/er;s to any n/•the following: <br />(I) A business whose principal place gf business is located in an affected county. <br />(2) A business that perns a major•io, of its pcmroll (in dollar volunne) to residents ol'cifteted counties. <br />(3) A business that employs residents of affected counties as a majority of its ernplgrc cs. <br />(4) A business that makes significant capital investments in the affected counties as defiucrl in rules url„pre d hi nine political <br />subdivision. <br />(5).4 business that has a substantial positive economic impact on the Affected counties us (lc,/irrrd hr criteria in r rrlrs adnplccl h) <br />the political subdivision. <br />An "affected count}" refer;, to St. Joseph County, Indiana, or thefilloi-ving counties located 11(1/rrcent to 1r. Joseph Couny•: <br />Elkhart County, Marshall County, Starke County and LaPorte County. <br />There are the,following price purchased•Jrom a local Indiana husiness: <br />• 5%for a purchase expected by the purchasing agency to be less than $50,000 <br />• 3% far a purchase expected Gv the purchasing agency to be at least $50, 000 but less Man S 100, 001)• <br />• I L. Lbr a urchase expected br the purchasing agency to be at least $100,000. <br />Date, <br />Pursuant to T.C. 35-1-1 I�IJ Ab�ArW � claims a local Indiana business <br />preference for Project P (Project # I located within the City of <br />South Bend, St. Joseph County, Indiana. <br />The location of the principal place of business is <br />St. Joseph County, Indiana <br />❑ The following county located adjacent to St. Joseph County, I ndiana: <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 ol'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 xhr€ll provide <br />supporting documentation for the 12 month period prior to the date of the Bid of (i) the total payroll <br />arnount 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 SECURITYNUMBERS. <br />Dated this day of , 20 <br />oC ntractor/ i a d e€ (F€rrn <br />Signat �Co acto •Bidder or Its Agent <br />1'7 <br />i•inted Name and Title <br />