Opening of Bids - Spec D - One or More 2018 or Newer 3-4 Ton Four Wheel Drive Pickup Trucks - Gates Chevy World

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(To be completedonly by ContraetorslBidders clainting to be a "local Indiana business "pursuant to LC 36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "local Indiana business " refers to any of thefollowing: (1) A business whose principalplace of business is located in an affected county. (2) A business that pays a majority of its payroll (in dollar volume) to residents of affected counties. (3) A business that employs residents of affected counties as a majority of its employees, (4) A business that makes significant capital investments in the affected counties as defined in rules adopted by the political subdivision. (5) A business that has a substantialpositive econoinic impact on the affected counties as defined by criteria in rules adopted by the political subdivision. An "affected county " refers to St, Joseph Couniy, Indiana, or thefollowing counties located adjacent to St. Joseph County: Elkhart Couno�, Mao -shall County, Starke Couno� and LaPorte County There are thefolloitiiigpricepreferei?cesfor supplies purchasedfi-ont a local Indiana 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 be at least $50, 000 but less than $100, 000. • 1%fior apurchase expected by the purchasing agency to beat least $100,000. Date: L� I t % Pursuant to LC. 36-1-12-22, 6pac-S claims a local Indiana business preference for Project W 0 0NO4 )OM fo�tk (Project # SpiEC 1) located within the City of South Bend, St. Joseph County, Indiana. ft'"f TiNCK The location of the principal place of business is 6s-'I 5- (4ddr-s) El St. Joseph County, Indiana E] The following county located adjacent to St. Joseph County, Indiana: 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. WHEN suppL yING SUPPORTING PA YROLL RECORDS, BIDDER SHALL REDACT ALL SOCIAL SECURITYNUMBERS Dated this 00�4 day of APPAt— —,20 1% CATES CAAW Contractoret Signature of Contractor/Bidder or Its Agent -'SK,A(AA� VW-kC Printed Name and Title H-4