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(To be completed only by ContractorsIBidders claiming to be a '7ocal Indiana business" pursuant to I. C. 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <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 />0 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 be atleast $100,000. <br />Date: Ll— 10--Zo%9 <br />Pursuant to I.C. 36-1-12-22, EA I(CIVVIK 'k vv-,,e 'A '2� 4- claims a local Indiana business <br />preference for Project 5.8f--L G P"�� Lo tZL:�" (Project # located within the City of <br />South Bend, St. Joseph Cbunty, Indiana. <br />0 The location of the principal place of business is Z-11 5 1 AJ 4- 6 3 <br />(Address) <br />St, Joseph County, Indiana <br />0 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 Bid 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 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 / 19 "r-111 day of 4f �r,'� 20)9 <br />L <br />&k6)jD8e--* I <br />CoAtractor/Bidder (Pttm) 13 <br />Si��.re(�V Cb-n-tractor/Bid der or Its Agent <br />(� " c V�) ax& 0 �-V 50J t <br />PdRed Ame and Title <br />M <br />