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(To be completed only by Contractors/Bidders claiming to be a `locallndiana business"pursuant to LC 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />7 "Total 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 On dollar volume) to residents of affected counties. <br />3) A,business that employs t 8idi3i of1`14V ai+ed Vounties of its e�ril;►to Kips: <br />(4) A business that maiYaix*�OW hipatments,lft tliofolled counties Ost ,find in rules adopted by the political <br />subdivision, <br />(5) A business that has a substantial posttive economic impact on the affected counties as defined by criteria in rules adopted by <br />the political subdivision. <br />An "affected county" refers to St, Joseph County, Indiana, or the following counties located adjacent to St. Joseph County., <br />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 />• ' 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 />Date: <br />Pursuant to I.C. 35-1-12-22, A claims a local Indiana business <br />preference for Project.. S . EC (Project # located within the City of <br />South Bend, St. Joseph County, Indiana, <br />Rr The location of the principal place of business is / D�� .. K/ y�sY, ; <br />(Addr—) <br />St. Joseph County, Indiana <br />❑ 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 SUMYING SUPPORTING PAYROLL RECORDS, <br />Dated this 16 H,� day of So <br />re or L;ontraVarMiaaer or <br />1rt�tr,J a 0-14v <br />Name and Title <br />