Opening of Bids - Spec T One or More Used Low Boy Tractor - Truck Centers Inc - Bid Security Check submitted

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(To be completed only by Contractors/Bidders claiming lobe a "local Indiana business "pursuant to LC. 36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "local Indiana business" refers to any of the following., (])A business whose principal place of business is located in ara affected county. (2) A business that pays a majority of its payroll (in dollar voliane) to residents of affected counties. (3) A bttsiness that employs residents of affected comities as a majority of its employees. (4) A business that makes significant capital investments in the affected counties as defined in rules adopted by the political subdivision. (5) A bttsiness that has a sttbstantirrl positive economic impact on the affected counties as defined by criteria in rttles adopted by the political subdivision. An "affected county" refers to St. Joseph Cotino), Indiana, or the following counties located adjacent to St. Joseph County: Elkhart Cottnty, Marshall County, Starke County, and LaPorte Coinq There are the following price preferences for supplies ptn•chased frrom a local Indiana business: • 5% for a purchase expected by the purchasing agency to he less than $50, 000 • 3%for a purchase expected by the purchasing agency to beat least $50,000 bw less than $100,000. • I % or a purchase expected by the ptirchasing agency to beat least $100, 000. Date: q /1)-- 10 _ Pursuant to T.C. 36-1-12-22, T2c4CK C.-PWT-F—+-�, I Me- o claims a local Indiana business preference for Project tt S ,(-, Q f !3W tie y `T AA-d,? 0 2 (Project # _`aFge- located within the City of South Bend, St. Joseph County, Indiana. [l The location of the principal place of business is /U (Address) ❑ St. Joseph County, Indiana ❑ The following county located adjacent to St. Joseph County, Indiana: dThe 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. ld 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. WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACT ALL SOCIAL SECURITYNUMBERS. Dated this / 1) day of ; 0r6 MOO" 20 19 TPt t.44 65APTZ-e S� I'y e- Conjctq,�dder (Firm) W�H-ature of C ghtr c rf dder or Its Agent Printed Name and Title