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(To be completed only by Contractors/Bidders clainning to he a "local Indiana husutess"pursaant to LC'. 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business" refers to airy of the, following.- <br />(1) A business ",hose principal place of'bitsiness is located in an c{ffectc courtly. <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 of ecfed counties as a majority af'ils employees. <br />(4) A business that makes sig=nifIcant capital investments in the gffected counties as defined in rides adopted by the political <br />.subdivision. <br />(5) A business that has a substantialpositive econontic 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 C'ouno,, Indiana, or the.1611mving counties located adjacent to St. Joseph Couny,: <br />Elkhart County, Marshall County, Starke County and LaPorte County <br />There are the. following price preferences for- supplies pin-c•hased. from a local Indiana business: <br />• 5%, for a purchase expected by the purchasing agency to be less than 550, 000 <br />• 3%for a purchase expected by the purchasing agency to be at least $50, 000 but less than $I00, 000, <br />• 1 %,for a purchase expected by the purchasing agency to heal least $100,000._- <br />Date: & 1,L( <br />/ <br />Pursuant to I.C. 36-1-12-222, c✓' ) f��? :� claims a local Indiana business <br />preference for Project (Project # } located within the City of <br />South Bend, St. Joseph County, Indiana. C <br />❑ The location of the principal place of business is _ ! 5� Jry 11P4 YG- <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 etrtployees 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 (lie 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 SUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SI1ALL REDACT ALL <br />SOCL4L SECURITYNUMBERS. <br />Dated this <2— (4) day of `J0 A) e 24 1 <br />Contractor/Bidder (f i n <br />Sigt ure o Contractor/Bidder or Its Agent <br />Printed Name anfl Title <br />8 <br />