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(To be completed only kyContractorViliddens (.-laiming to be a "local Indiana business"'pursuant to LC 36-1-12-22)
<br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM.
<br />A '"local Indiana business" ri? ,P,rs to any qf the,1611owing:
<br />(1) A business w, hose principalphice qflyusiness is located in an affected county,
<br />(2) A business that pays a ma ority qfits payroll (in dollar vv/ume) to residenu qfq#inted counties.
<br />(3) A business that eniplqys residents ql'af tected counties as a meyorih, of its enz )Ioj,,e( v.
<br />(4) A business that makes significant capital invesonents in the qftected countias as dqfine�d in rules adoptedby thepolitical
<br />subdii4sion.
<br />(5) A business that has econoinic inipact on the qffected counties, as defined by criteria in rules adopted fay
<br />the political subdivision.
<br />An "a �cted count " I I
<br />'ffi y re/ers to St. doseph ('crusty, Indiana, or the,161lowing counties located a4jacent to 51 Joseph County:
<br />Elkhart County, Marshall Coun�j� Starke County and.LaPorte County
<br />Ther( , are the fiollowing price pre V lerences./br supplies purchasedftonz a local Indiana busines,
<br />• 5%ff)?-aptitc.,haseeY1,7(?ctedlast the l.)ttrchaviiigagency , tea he lt?,v,�,th ' tin $50,000
<br />• 3%,Ii)t-aput-chaveexj?cctedb,,y"the t.aurc�hasingagency ter beat least $50,000but tess than $100,000.
<br />• 1%for, etpurchaseert)t?(.,Iedbvthen t)urch4isinf,),af,,c?ti,(,'vtea beat least $100,000,
<br />V,
<br />pursuant to I.C. 5-22-15-20.9' 'cv'vvs _L-1 claims a. local Indiana business
<br />preference for ]'reject V
<br />'r'J L (Prqject # located within the City of
<br />South Bend, St. Joseph County, Indiana.
<br />The location of the principal place of business is 'ZA\ � Y [t
<br />Ll 6311
<br />St. Joseph County, Indiana
<br />The following county located aqjacent 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 />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 rioted 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 pc6od prior to the date of the Bid of (i) the total payroll
<br />arriOUnt paid to all employees of the business, and (ii) the total payroll arnount paid to ernployees who are
<br />residents of St. Joseph County and the adjacent county noted a1iove.
<br />WHEN SUPPL YING SUPPORTING PA YROLL RECOR,AVM BIDDER sHALL RERWTALL
<br />SOCIAL SECURITYNUMBERS.
<br />Dated this day of_-�A' -0 20- 2 -
<br />,on e for/Bid l irm
<br />of ctor/Bidder or Its Agent
<br />Si natu
<br />(A vt &
<br />rin d liar and Title d
<br />I
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