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(To be completedonlyby ContraetorslBidders clahning to be a "local Iii(liaitabitsiiiess"pilrstialit to LC 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business " refers to any of thefollowing: <br />(])A business whoseprincipalplace of business is located in an affected count)'. <br />(2) A business that pays a majority of its payroll (in dollar voluin e) to residents of (iffected counties. <br />(3) A business that eniploys residents of affected counties as a inajority of its einployees. <br />(4) A business that in akes significant capital invesinients in the affected counties as defined hi rules adopted by the political <br />subdivisioit <br />(5) A business that has a substantial positive econontic hnpact on the affected counties as defined hy criteria in rules adopted �y <br />the political subdivision. <br />An "offected county " refers to St. Joseph County, Indiana, or thefollowing counties located adjacent toSt, Joseph Couno�: <br />Elkhart Coun4� Marshall County, Starke Couno� and LaPorte County <br />There are thefolloivingpi-icepi-eferencesfoi-szippliespity-cl?asedfi-oin a local Indiana business: <br />0 5%for apurchase expected by the purchasing agency to be less than $50, 000 <br />. 3%for a purchase expected by the purchasing agenop to beat least $50, 000 but less than $ 100, 000. <br />- 1%,for a purchase expected bj� the purchasing qgenq� to beat least $100, 000, <br />Date: APRIL 10, 2018 <br />Pursuant to I.C. 36-1-12-22, JORDAN FORD — claims a local Indiana business <br />preference for Project 3/4 TON 4X4 PICK UP TRUCK_ (Project# SPEC D located within the City of <br />South Bend, St. Joseph County, Indiana. <br />Fx� The location of the principal place of business is 609 E JEFFERSON BLVD,MISHAWAKA, IN 46545 <br />(Addrtss9 <br />St. Joseph County, Indiana <br />The following county located adjacent to St. Joseph County, Indiana: <br />F-X1 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 />F-xl 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 arnount paid to employees who are <br />residents of St. Joseph County and the adjacent county noted above. <br />WHEN SUPPL YING SUPPORTING PA YROLL RECORDS, BIDDER SHALL REDA CT ALL <br />SOCIAL SECURITYNUHWERS <br />Dated this - 10 TH day of APRIL —,20 18 <br />JORDAN FORD <br />Co t t /Bidder(Firin). <br />=, Nt6�-, <br />Siviature of Contractor/Bidder or Its Agent <br />D BRA STARKWEATHER <br />Printed Name and Title <br />8 <br />