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EMISSIONS! III <br />W, ROM, R! "t, m=ps�1111 <br />A 'local Indiana business" refers to any of the following: affected county. <br />(1) A business whose principal place of business is located in an <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 affected counties as a maj ofity of its emp/oyee& <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 />0 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 />agency tobe�atleas.t$100,000- <br />Date: <br />- for a�ur�ce expected b the purchasing —WI% f 470 claims a local Indiana business <br />Pursuant to I.C. 36-1-12-22, <br />preference for Project (Project # —) located within:, the City of <br />South Bend, St. Joseph County, Indiana <br />The location of the principal place of business is (Add -SS) <br />St. Joseph County, Indiana <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 />0 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, indian@, or the adjacent county noted above. <br />If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shafi provide <br />supporting; documentation for the 12 month period prior to the date of the Bid of (i) the total payroll amount <br />paidi to alle'mPloYees 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 abovei. <br />WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, <br />ISOCIAL SECURITY NUMBERS;, <br />BD Lz� <br />Dated, this day of 1 20_- <br />rzmznma��� <br />Version 8 — 02/25/14 <br />