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(To be completed only by Cotytr•actorsBielelers elaittting lobe a "local ln(liana business"prrrsrrrrrrt to LC. 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business "r&rs to any nf'tltefollo+ving: <br />(I) A business whose principal place of husiness is located in an affected count+. <br />(2) A business that prrvs a majoriti, of ifs payroll (in dollar volume) to residents of cffecfed rorurtic•s•. <br />(3) A business that employs residents of'rfjec led counties as a majority oJ'its employees. <br />(4) A business that makes significant capital investments in the affected counties as defined in rules aclrrptc•d h+' the political <br />subdivision. <br />(5) A business that has a substantial positiyc� economic impact on tine affected counties as dc;fincd hr crircria in rules adopterl hi' <br />the political subdivision. <br />An "affected county"r'efens to St. Joseph County, Indiana, or the fallowing counties located adjaccrtt to 5t. Joseph County: <br />Elkhart County, Marshall County, Starke County and LaPorte County. <br />There are the follox'irng price preferences for .supplies purchased froth a local Indiana btr.sinc's.s: <br />• 5%,for a purchase expected ley the purchasing agency to be less than $50,000 <br />• 3%Jo1- a purchase expected by the purchasing agency to beat least $50,000 but less than tit 00.000. <br />• IY Jor a purchase expected by the purchasing agency to be at least $100,000. <br />Date: 9-9-117 <br />Pursuant to I.C. 36-1-12- 2, claims a local Indiana business <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 19& /A69 G Q( <br />St. Joseph County, Indiana ! v <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 Bic{ 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 €his 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' 0) the total payroll <br />amount paid to all employees of the business, and (ii) the total payroll amount paid to employee~ who are <br />residents of St. Joseph County and the adjacent county noted above. <br />WHENSUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACT ALL <br />SOCIAL SECURI'IITYNUMBERS. <br />Dated this3,t!91--- day of , 20 <br />1 <br />Contracto Bi er (Firm) <br />r <br />Signa are o C tira or/Bidcic• or• I ti `Lent <br />lam✓ r� <br />Printed Name and Title <br />