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(To be completed only by ContractorslBidders claiming to be a "local Indiana business"pursuant to 1. C. 364-12-22) <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 affected counties. <br />(3) A business that employs residents of affected counties as a ingiority of'its employees. <br />(4) A business that makes significant capital investments in the affected counties as defined in rules adopted by the political <br />subdivision. <br />(51 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 "afjetted county" refers to St. Joseph County, Indiana, or the folloivirtg counties located adjacent to St. Joseph County; <br />Elkhart County, A1arshall County, Starke County and LaPorte Counly <br />There are the following price preferences for supplies pztrchased from a local Indiana business; <br />• J % 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 be at least $50, 000 but less than $100, 000. <br />• 1 % for a purchase expected bv the purchasing agency to be at least $IOp, 0110. <br />Date: 4/ i2/2021 <br />Pursuant to I.C. 36- I-12-22, claims a local Indiana business preference <br />for Project New Nor i. zo_ nta l, rr i. ndc (project # )located within the City of South Bend, <br />St. Joseph County, Indiana. <br />M <br />The location of the principal place of business is 3 s 10 Co i, i. s eum 6 L vd Ft . Hday ne , <br />(Address) <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 />❑ 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, 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 <br />amount paid to all employees of the business, and (ii) the total payroll amount paid to employees who are <br />residents of St. Joseph County and the adjacent county noted above. <br />WHEN <br />SUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL_ REDACTALL <br />SOCIAL SECURITYNU1t1BERS. <br />- <br />Dated this 12 -bh day of, 20 2 1 <br />Inc. <br />Contractor/Bidder <br />Vermeer of 1 ndi, ana, <br />(Firm) <br />4 <br />of Contractor/Bidder or Its Agent <br />Troy Gipson, �•al,es I''!ano;�et^ <br />Printed Name and Title <br />0 <br />nr <br />1 <br />