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(To be completed only by ContractorslBidders clahning to be a "local Indiana busineNs " pursuant to 1. C 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business " refers to any of thefollowing: <br />(I)A business whose principal place of business is located in an affected county, <br />(2) A business that pays a majority of its pTmoll (in dollar volume) to residents of affected counties. <br />(3)A business that employs residents of affected counties, as a mqjorio� 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 />(5) A business that has a substantial positive econoinic impact on the affected counties as defined by criteria in rules adopted by <br />the political subdivis ion. <br />An "affected county " refers to St. Joseph County, Indiana, or thefollowing counties located adjacent to St. Joseph County: <br />Elkhart Couni)� Alai -shall Couni)� Starke County and LaPorte Couno� <br />There are thefollowing price preferences.for supplies purchasedfrom a local Indiana business, <br />• 5%for apurchase expected by 1hepurchasing agency to be less than $50,000 <br />• 3%for a purchase expected by the purchasing agenq� to beat least $50, 000 but less than $ 100, 000, <br />• lYo or a purchase expected by the purchasing qgency to be at least S100, 000. <br />Date: MAgcTq 27, 9018 <br />Pursuant to I.C. 36-1-12-22, JORDAN FORD <br />preference for Projecl SPEC A AWD UTILITY VEHICLE (Project 4 <br />South Bend, St. Joseph County, Indiana. <br />claims a local Indiana business <br />SPEC A ) located within the City of <br />Fx The location of the principal place of business is 609 E JEFFERSON BLVD - , MI.SHAVAKA, IN : 46545' <br />(,Iddress) <br />St, Joseph County, Indiana <br />The following county located adjacent to St. Joseph County, Indiana: <br />Rx 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 />Rx The majority of the business's ernployces 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 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 />WHENSUppLyING suppORTING PA YROLL RECORDS, BIDDER SHALL REDACTALL <br />SOCIAL SECURITYNUMBERS <br />Dated this 27TH day of MARCH 20 18 <br />JORDAN FORD <br />Contractor/Bidder (Hrm <br />A� <br />sig�,eature of Contractor/Bidder or Its Agent <br />COMMERCIAL FLEET SALES MANAGER <br />DEBRA STARKWEATHER <br />Printed Name and Title <br />H., <br />