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(To be completed only by ContractorslSidders claiming to be a "local Indiana business" pursuant to L C. 36-1-12-22) <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 volume) to residents of affactedcounties, <br />(3) A business that employs residents of affected counties as a majority of its employees. <br />(4) A business that makes significant capital investments in the affected counties as defined in rules adopted' by the <br />political subdivision. <br />(5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rules <br />adopted by the political subdivision. <br />An "affected county" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Joseph <br />County 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 />* 1 % for aSurchase erected y thepurchq§L arcy o be, t least 0000 <br />Date: <br />Pursuant to IC, 36-1-12-221 aims a local Indiana business <br />preference for Project <br />(Project # located within the City of <br />South Bend, St, Joseph County, Indiana, <br />U The location of the principal place of business is LA 2—L It-t, <br />S� <br />11 St. Joseph County, Indiana (Adolms ?A LL q-�r <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 />D The majority of the blusiness"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, 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 amount <br />paid to all employees of the business, and (H) the total payroll amount paid to employees who are residents <br />of St. Joseph County and the adjacent county noted: above. <br />Uyl �"A <br />Dated this, 3 day of 202-0 <br />C ntract i na use <br />COMMONWLALi n Ul- HENN6 2 -L V A N <br />COMNA494W 8LA k1.N5YLVAN1A <br />-n—Jonn y ic <br />I ry C <br />-IfifillwWASMAary Public <br />c5021, 5 <br />LM y C �am r�j s s = ices <br />