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(To be completed only by CoutractorslBidders clahning to be a "local Indiana business" pursuant to I.C. 36-I-I2-22) <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 vohone) 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 »takes significant capital investments in the affected counties as defined in rules adopted by the political <br />subdivision. <br />(5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rides adopted by <br />the political subdivision. �- <br />An "affected county" refers to St. Jvseph CountJ�, Indiana, or the following counties locaIdd,t to St. Joseph Count) <br />Elkhart Count), Marshall County, takke County and LaPorte County <br />There are the following price prefer ices for supplies purchased fi•ortt a local lIndiana <br />• 5% far a purchase expected by he purchasing agency to be less than $• 3%for apurchase expected by t epurchasing agency to beat least $50ess than $100,000. <br />• I% for a purchase expected by the urchasiniz agency to beat least $10 <br />Date: <br />Pursuant to I.C. 36-1-12-22, <br />preference for Project <br />South Bend, St. Joseph County, Indiana. <br />claims a local Indiana business <br />(Project # ) located within the City of <br />❑ The location of the principal place of iness is <br />(Address) <br />❑ St. Joseph County, India <br />❑ The following coon ocated adjacent to Joseph County, Indiana: <br />❑ The majority of the busi s's payroll for the 12 mon s prior to the date of this Bid is to residents of St. <br />Joseph County, Indiana r the adjacent county noted abo . <br />❑ The majority of the usiness's employees for the 12 months for to the date of this Bid are residents of <br />St. Joseph County ndiana, or the adjacent county noted above. <br />If the business is deem d to be the apparent lowest, responsible, responsi bidder, then it shall provide <br />supporting document ion far the 12 month period prior to the date of th Bid of (i) the total payroll <br />amount paid to all ployees of the business, and (ii) the total payroll amount aid to employees who are <br />residents of St. J eph County and the adjacent county noted above. <br />WHEN SUPPLYING SUPPORTING PAYROLL <br />BIDDER SHALL REDACTALL SOCIAL SECURITY NUMBERS. <br />Dated this day of , 20 <br />Firm Name <br />Name and Title <br />Signature <br />