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(To be completed only by Contractors/ Bidders claiming to be a "local Indiana business" pursuant to I. C. 36-1-12-22) <br />INDIANA LOCAL BUSINESS PREFERENCE CLAIM <br />A "local Indiana business"refers to any of the A6116imfing: .................................... . .. . ......... - . .................................... . . 111 ------- ----------- I .......... - <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 volume) to residents of affected counties. <br />(3) A business that employs residents of affected counties as a majority of its employees. <br />political sub•ivision. <br />adopted by the political subdivision. <br />An "affected county" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Jose <br />County., Elkhart County, Marshall County, Starke County and LaPorte County i <br />There are the following price preferences for supplies purchased from 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 the purchasing agency to beat ieast $50,000 but less than $100,000. <br />* 1% for,a Purchase expected Py he�,p tqg .0, q_qy_tq..be at least $ 100, 00 <br />Date: <br />Pursuant to I.C. 36-1-12-22, claims a local Indiana business <br />preference for Project (Project#) located within the City of <br />South Bend, St. Joseph County, Indiana. <br />The location of the principal place of business is <br />.................. — . ............... .......... ....... .. <br />(Add-mq) <br />11 St. Joseph County, Indiana <br />a 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 />WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, <br />BIDDER SHALL REDACT ALL SOCIAL SECURITY NUMBERS. <br />. . ........... . . ............ <br />Contractor/Bidder (Firm) <br />. ............................................ <br />Printed Name and Title <br />