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(To be completed only by Contraetors:Midders claim ing to be a "local Indianabusiness"pursuant to LC. 36--l-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business " refers to any of thefollolving: <br />(1) A business whoseprincipal place of business is located in an affected county. <br />(2) A business thatpays a majority of its payroll (in dollar volume) to residents of affected counties. <br />(3) A business that employs residents of affected counties as a majority 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 substantialpositive economic 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 County, Indiana, or thefollowing counties located adjacent to St. Joseph County: <br />Elkhart County, May -shall County, Starke County and LaPorte County <br />There are thefollowing price preferences for supplies purchasedfrom a local Indiana business: <br />• 5%for a purchase expected by the purchasing agency to be less than $50, 000 <br />• 3%for a purchase expected by thepurchasing agency to beat least $50,000 but less than $100 000. <br />• 1%6for ypurchase expected by the purchasing agency to beat least $100,000. <br />Date: )3 <br />t zi clAidl kl�op_t- ID <br />Pursuant to I,C. 36-1-12-22, W-( Tl� S claims a local Indiana business <br />preference for Project _ C=, PC C— C— (Project # located within the City of <br />South Bend, St. Joseph County, Indiana. <br />F)q The location of the principal place of business is 6tkvDC6VNC <br />(Addr-s) <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 employees 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 />WHEN SUPPLYING SUPPORTING PA YROLL RECORDS, BIDDER SHALL REDACT ALL <br />0 SOCIAL SECURITYNUMBERS. <br />Dated this . ..... .... . . day of 20 1 '� <br />A T <br />-211 E�, le <br />6ritractor der(�V <br />Signature of Contractor/Bidder or Its Agent <br />SAOU&J �MLF, F(C-Er <br />Printed Name and Title <br />