Opening of Quotations - Janitorial Supplies 2018 - KSS Enterprises

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(To be completed only by Contractor•slHidder:s claiming to be a "local Indiana husines's"pursuant it) I.C..36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM ................. A "local hndtatna business" refers to any o/ the follois+ing: (1) A business whose principal place gf'brrsiness is located in an ajffcted county. (2) A business that pays a majorio, of its payroll (in dollar whine) to residents of affected counties. (3) A btt.shress that employs residents of afJectcd counties as k tuajaritj of its employees. (4) A business that makes significant capital investments in the aj]ected counties as dented in rules adopted by the political subdivision. (5) A business that has a ,substantial positive econontic impact on the crffecled counties as defined by criteria its rales adopted bythe political subdivision. An "affected county" refers to St. Joseph County, Indiana, or the fallowing counties located adjacent to St. Joseph Corarty: Elkhart County, Marshall County, Starkc County and LaPorte County There are the followirng price preferences for supplies purchased from a local Indiana business; • 5%fora purchase expected 1»> the purchasing agency to be less than $50,000 • 3%for a purchase expected 41, the purchasing agency to beat least S50,000 but less than $100,000, • 1 % fora purchase ex reeled by the purchasing a encv to be al least $100, 000. Date: Pursuant to I.C. 36-1-12-22, preference for Project South Bend, St. Joseph County, Indiana. ❑ The location of the principal place of business is claims a local Indiana business (Project # ) located within the City of (Andress) ❑ St. Joseph County, Indiana ❑ The following county located adjacent to St, Joseph County, Indiana: ❑ The majority of the business's payroll for the 12 months prior 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 rioted above. If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shall provide supporting docrnnentation 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. WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACTALL SOCIAL SECURITYNUMBERS. Dated this day of 20 Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent Printed Name and Title