Opening of Bids - Spec Q - Two More or Less 2018 or Newer Refurbished Medic Units - Fire Services Inc.

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(To be completed only by ContractorsIBIdders claimbig to be a "local Indiana business " pursuant to L C. 36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "local Indiana business " refers to any of the following: (1) A business whose principal place of business is located in an affected county. (2) A business that pays a majority of its pqyroll (in dollar volume) to residents of affected counties. (3) A businewg that employs resideigs of affected counties.as.a majorily of Lts einployee.s.. (4).4 business that makes significant capital investments in the affected counties as defined in rules adopted by the political subdivision, (5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rules adopted by the political subdivision. An "affected county " refers to St. Joseph County, Indiana, or thefollowing counties located adjacent to St. Joseph County: Elkhart County, Mai -shall County, Starke County and LaPorte County There are the.followingprice prqferencesfior supplies purchased./roin a local Indiana business: • 5%for apurchase expected by the purchasing agency to be less than $50,000 • 3%for a purchase expected by the purchasing agency to beat least $50, 000 but less than$] 00, 000, • I %fior a put -chase expected by the purchasi�lg.qgenqy to beat least$] 00, 000. Date: Pursuant to I.C. 36-1-12-22, preference for Project South Bend, St. Joseph County, Indiana. claims a local Indiana business (Project located within the City of The location of the principal place of business is =5�-- To 27;�J PM "-J 4 — eA X-e 64?�J (Address) St. Joseph County, Indiana The following county located adjacent to St. Joseph County, Indiana: The majoCity of the business's payroll for the 12 months pfior to the date of this Bid is to residents of St. Joseph County, Indiana or the adjacent county noted above. The majority of the business's employees for the 12 months prior to the date of this Bid are residents of St. Joseph County, Indiana, or the adjacent county noted above. If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shall provide supporting documentation for the 12 month period prior to the date of the Bid of (i) the total payroll amount paid to all employees of the business, and (ii) the total payroll amount paid to employees who are residents of St. Joseph County and the adjacent county noted above. WHENSUPPLYING SUPPOWTING PAYROLL RECORDS, BIDDER SHALL REDACTALL SOCL4L SECURITY NUMBERS. Dated this day of 20. Not J(t� i - , wj�l Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent Printed Name and Title 8