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(To be completed only by Contractors/Bidders claiming to be a 'local Indiana business" pursuant to i.C. 36-1-12-22) <br />HIs] I:.PL1110Z01-1->l0MIN, C IM-212li I:[SA2 W�[91WETi, <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 adopted by the <br />political subdivision. <br />(5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rules <br />adopted by the political subdivision. <br />An "affected county" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Joseph <br />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 $100, 000. <br />• 1 % for a purchase expected by the purchasing agency to beat least $100,000. <br />Date: 02/23/2018 <br />Pursuant to I.C. 36-1-12-22, TRUCKS R US INC claims a local Indiana business <br />preference for Project Belt Pressed Biosolids for land application (Project ff ) located within the City of <br />South Bend, St, Joseph County, Indiana. <br />n The location of the principal place of business is 23942 State Road 2 South Bend IN 46619 <br />(ACGrOSS) <br />X St. Joseph County, Indiana <br />11 The following county located adjacent to St. Joseph County, Indiana: <br />X 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 />X 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, <br />BIDDER SHALL REDACT ALL SOCIAL SECURITY NUMBERS. <br />Dated this 23rd day of February, 2018 . <br />Inc <br />CogractprlBidder (5irm) <br />SignIsst <br />re of ContractbriBldder or Its Agent <br />m Jan - President <br />Printed dame and Title <br />Ver. 13 — 6101115 <br />