Opening of Bids - Seitz Park Reconstruction Phase I Proj No. 117-093A - Northern Indiana Construction Co., Inc.

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(To be completed only by Contractors/Bidders claiming to be a "locallndiana business" pursuant to LC. 36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "locallndiana business" refers to any of thefollowing: (])A business whose principal place ofbusiness is located in an affected county. (2) A business thatpays a majority of its payroll (in dollarvolume) to residents of affected counties. (3) A business thatemploys residents ofaffected counties as a majority of its employees. (4) A business that makes significant capital investments in the affected counties as defined in rules adopted bythepolitical subdivision. (5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rules adopted by the political subdivision. An "affected county"refers to St. Joseph County, Indiana, or thefollowing counties located adjacent to St. Joseph County: Elkhart County, Marshall County, Starke County and LaPorte County There are thefollowingpricepreferencesforsuppliespurchasedfrom a locallndiana business: • 5%for a purchase expected by thepurchasing agency lobe less than$50,000 • 3%for a purchase expected by thepurchasing agency to beat least $50,000 but less than $100,000. the Date: Pursuant to I.C. 36-1-12-22, to be at least claims a local Indiana business preference for Project (Project# ) located within the City of South Bend, St. Joseph County, Indiana. ® The location of theprincipal place of business is 1125 7th Street E St. Paul MN 55105 (Address) ❑ St. Joseph County, Indiana ❑ The following county located adjacent to St. Joseph County, Indiana: ❑ The 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. ❑ 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 forthe 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 day of ,20 ( PeT evov+6eD) MacQueen Equipment, LLC dba MacQueen Emerpencv Grou Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent _Dave Polkow - Sales Representative sdurx8 Printed Name and Title Ftio u SPECIFICATIONS rVAcx y 7 :r 1865