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(To be completed only by Contractor slBidders claiming to be a "local Indiana bzrsiness'pnr snant to LC. 36-1-1.2-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business" refers to any of the following: <br />(1) A business whose principal place of business is located in an affected county. <br />(2) A business that pays a majority of its payroll (in dollar vohtme) 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 <br />the political subdivision, <br />(5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in mks <br />adopted by the political subdivision. <br />An "affected county" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Joseph <br />County: Elkhart County, Marshall County, Starke County and LaPorte County <br />There are the following price preferences for supplies purchased from a local Indiana business: <br />• 5010 for a purchase expected by the purchasing agency to be less than $50,000 <br />• 3%fora purchase expected by the purchasing agency to be at least $50,000 but less than $100,000. <br />Date: June 6, 2018 <br />Pursuant to I.C. 36-1-12-22,HP Products Corporation does not claim a local Indiana business <br />preference for Project Janitorial <br />Supplies 20t8 (Project # N/A ) located within the City of <br />South Bend, St. Joseph County, Indiana, <br />❑ The location of the principal place of business is 4220 Saguaro Trail, Indianapolis, IN 46268 <br />tAda,-essj <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 St. <br />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 amount <br />paid to all employees of the business, and (H) the total payroll amount paid to employees who are residents <br />of St. Joseph County and the adjacent county noted above. <br />WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACT ALL <br />SOCIAL SECURITYNUMBERS. <br />Dated this A! day of June ,20 18 <br />HP Products Corporation <br />Contractor/ idder ( rz <br />Signature Contractor/Bidder or Its Agent <br />Cy Nahvi, General Manager <br />Printed Name and Title <br />