Laserfiche WebLink
(To be completed only by ContractorslBieliler,8, claiming to be a "local Indiana business" pursuant to LC. 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />"local India, <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 />1 <br />(2) A business that pays a majority of its payroll (in dollar volume) to residents of affected counties. <br />business <br />ss <br />3) A business <br />( ) h"" . majority (3) A business that employs residents of affected counties as a aiO iYofits employees. <br />4) A business that makes 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 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 Coun: <br />Elkhart County, Marshall County, Starke County and LaPorte County ty <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 Lk'ASS —than $50, 000 <br />- 3 %for a purchase expected by the purchasing agency to be at least $50, 000 but less than $] 00, 000. <br />o be at least $10,0, 000. <br />Date: <br />Pursuant to I.C. 5-22-15-20.9, <br />preference for Project <br />South Bend, St. Joseph , County- <br />, Indiana. <br />claims a local Indiana business <br />(Project # <br />located within the City of <br />❑ The location of the principal place of business is <br />El St. Joseph County, Indiana <br />El The following county located adjacent to St. Joseph County, Indiana: <br />E] I'llc MaJOritY Of the business's payroll for the 12 months prior to the date of this Bid is to residents of <br />-10SOP11 County, Indiana or the adjacent county noted above. St. <br />El The majority of the business's employees for the 12 months prior to the date of this Bid are residents of St. <br />Joseph County, Indiana, or the adjacent county noted above. <br />If the business is deemed to be the apparent lowest, responsible re 11 then it $hall ],)rovide <br />period prior to the date of the Bid of(i the total payroll amount <br />supporting documentation for tile 12 month Pei , SPO sive bidder, <br />paid to all employees of the business, and (ii) the total payroll all]OU <br />of St. Joseph County and the ad,l�acent COUntY rioted above. 'It paid to employees who are residents <br />WHEN SUPPL YING Stlpp()R T'N(; PA YROU RECORDS, BIDDER SHA LL RE, D,4 CT <br />SOC1,11 L -S`ECURI it Y NUAIRE, RS� <br />Dated this day of 2 0, <br />Contl'actOr/Bidder (Finn) <br />Signature ofC <br />011011clor/Bidder or Its Agent <br />Printed Name aiiid�Tijie <br />