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10111 FROEIN 1[616�111wl 10 MUN Dog 31H <br />A "local Indiana business" refers to any of the fallowing: <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 affected counties. <br />(3) A business that employs residents of'qffected counties as a majority of'its employees. <br />(4) A. business that makes sign ificant 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 theft)[lowing counties located adjacent to ,St. Joseph County: <br />Elkhart County, Uarshall County, ,Starke County and LaPorte County <br />There are the following price preferences,for supplies purchased from a local Indiana business: <br />5%ft)r a purchase expected by the purchasing agency to be/,., -1hyn $50, 000 <br />em ­­- <br />3%ji)r apurchase expected kvthe purchasing agency to be at least $50,000 but less than,S100,000, <br />I a 'lIase tv n _ygency� to be at least $100,000. <br />purck, j, ........ . . . . ..... <br />Date: <br />Pursuant to I.C. 36-1-12-22, ­­­ . ........... ­­­­ — ---- - ------ . .............. claims a local Indiana business <br />preference for Project—--- (Project located within the City of <br />South Bend, St. Joseph County, Indiana. <br />E] The location of the principal place of business ism —... <br />E] St. Joseph County, Indiana <br />E] The following county located adjacent to St. Joseph County, Indiana: . ............ . .......... ­­ ...... <br />El 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 />E] 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 amount <br />paid to all employees of the business, and (ii) the total payroll amount paid to employees who are residents <br />of St. Joseph County and the adjacent county noted above. <br />WHEN SUPPL YING SUPPOR TING PAY OLL RECORDS, BWQ1X..=, LL R U2J, UAL <br />IaLTIALIL'"JULLYLI LES <br />Dated this of 120 <br />Contra c�ldd�r —(Firin) ' ­""' - --------- <br />. ........ .. ­ . . ....... . <br />Signature ofContractor/Bidder or Its Agent <br />P 'r, I "n'" t ed Name and d, , , " Ii i I e <br />Ver. 2 -- 4/16/12 <br />