Opening of Quotations - Janitorial Supplies 2018 - South Bend Chemical

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(To be completed only by Contracto)-,5lBidilerselaiiiiing to be a "localladianabusiness "pursuant to I.C. 36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "local Indiana business " refers to any of theJbIlowing: (1) A business whose principal place of business is located in an affected county. (2) A business that pays a majority of its payroll (in dollar volume) to residents of q1 ected counties. (3) A business that employs residents of affected counties as a majority of its employees. (4) A business that snakes significant capital investnients in the affected counties as dq1ined in rules adopted by the political subdivision. (5) A business that has a substan lial positive economic impact on the affected counties as defined by criteria in rules adopted by the political subdivision. An "q&cted counly " rqfers to St. Joseph County, Indiana, or thefillowing counties located adjacent to St. Joseph County: Elkhat -t County, Marshall County, Starke County and LaPorte County There are the follou4iigpricepi-eferencesfor supplies purchasedfi-ont a local Indiana business: 5%Jbr apurchase expected by the purchasing agency to be less than $50,000 • 3%for apurchase expected by the purchasing agency to beat least $50,000 but less than $100,000. ]%Jbrapurchayee-vpectedbyfliepui-cl?a.vtngqffetig y to he at least $100,000. Imo. Date: UA.,)e Pursuant to I.C. 36i_- -1-12-22., S"C' 11,61 C, 111 e11141claims a local Indiana business ;e ef A, preference for Project Vciej o 40,`;cit - (Project # located within the City of South Bend, St. Joseph County, Indiana. The location of the principal place of business is �4 5 /J) (Addtess) St. Joseph County, Indiana ❑ The following county located adjacent to St. Joseph County, Indiana: F-1 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. F-1 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 PA FROLL RECORDS, BIDDER SHALL REDACT ALL SOCIAL SECURITYNUMBERS Z�"/,(// Dated this day of V7-e"p 20 /,,idder Firm actor ) A0 c') _Signature of Contractor/BiAder or Its Agent 1""'157 Printed Name and Title