Opening of Bids - One or More 2017 or Newer Single Axle 4x4 Dump Truck with Contractor Dump Bed Spec Z - Truck Centers, Inc. dba Hill Truck Sales

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(To be completed only by Contractors/Bidders claiming to be a "locallndiana business" pursuant to LC. 36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "locallndiana business "refers to any of thefollowing: (1) A business whose principal placeofbusiness is located in an affected county. (2) g business thatpays a majority of itspayroll (in dollarvolume) to residents of affected counties. (3) A business that employs residents ofaffected countiesas a majority of its employees, (4) R business that makes significant capital investmentsin the affected counties as defined in rules adopted by thepolitic al subdivision. (5) A business that has a substantial positive economic impact on the affected countiesas defined by criteria in rules adopted by the political subdivision. An "affected county " refers to St. Joseph County, Indiana, or thefollowing counties locatedadjacent to St. Joseph County: Elkhart County, Marshall County, Starke County and LaPorte County There are thejollowingprice preferences for• suppliespurchased fr'onr a locallndiana business.- * 5%for a purchase expected by the purchasing agency to be less than $50,000 • 3 % for a purchase expected by the purchasing agency to beat least $50, 000 but less than $100, 000. • I % for a purchase expected by the purchasing agency to beat least $ ] 00, 000. Date: Gig ZJ Z,26) % Pursuant to I.C. 36-1-12-22, -F9" C,e /NC, "//,1 ItC WW,-K,�: laims a local Indiana business preference for Project./At6�.,E A)) LE- 21-14 y r? (Project 7 ) locatedwithin the City of South Bend, St. Joseph County, Indiana. /bf/ GJ . 5 4-7" PL1z (] The location of the principal place of business is � uT7-� W D, /*/, 4,/ (Address) St. Joseph County, Indiana ❑ The following county located adjacent to St. Joseph County, Indiana: ru] The majority of the business's payroll for the 12 months prior to the date of this Bid is to residents of St. Joseph County, Indiana or the adjacent county noted above. The majority of the business's employees for the 12 months prior to the date of this Bid are residents of St. Joseph County, Indiana, or the adjacent county noted above. If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shall provide supporting documentation for the 12 month period prior to the date of the Bid of (i) the total payroll amount paid to all employees of the business, and (ii) the total payroll amount paid to employees who are residents of St. Joseph County and the adjacent county noted above. WHENSUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACTALL SOCIAL SECURITY NUMBERS. T14 Dated this �'� day of �f �-10ek - , 20 i Contr for/Bidder (Firm) i a e of o ra /Bder or Its Agent Printed Name and Title 8