Opening of Quotations - Janitorial Supplies 2018 - Interboro

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(To be coinpleted only, by, Contractors1flidders clabn ing to be a "local Indiana business " pursuant to L C. 3 6-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "local Indiana business " rqfers to any of theJbIlowing: (1) A business whose principal place of business is located in an affected coi in ty, (2) A business that pays a majority of its payroll (in dollar volume) to residents of affected counties. (3) A business that einploys residents of affected counties as a niajoril), of its einployees, (4) A business that inakes significant capital hwestinents in the affected counties as deftned in rules adopted by the political subdivision. (5) A business that has a substantialposifive econontic Mipact on the qf .fecled counties as dqfined by criteria in rules adopted by the political subdivision. An "affected county,"" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Joseph County Elkhart County, Marshall County, Starke County, and LaPorte County There are the following price preferences for supplies purchased .from a local Indiana business: . 5%fir apurchase expected by the purchasing agency to be less than $5000 . 3%for a purchase expected by the purchasing agency to beat least $50, 000 but less than $100, 000. - 1%,/br a purchase expected by the put -chasing agency to beat least $100,000. Date: Pursuant to I.C. 36-1-12-22, preference for Project South Bend, St. Joseph County, Indiana, claims a local Indiana business (Project # located within the City of ❑ The location of the principal place of business is (Address) ❑ St. Joseph County, Indiana ❑ The following county located adjacent to St, Joseph County, Indiana: E] 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. E] 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 SUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDA CTALL SOCIAL SECURITY NUMBERS Dated this - day of 911 Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent Printed Name and Title