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Home My Public Portal About004-2018 - Sanitation - Smith Implements - 2 John Deer UTVsPURCHASE AGREEMENT ORIGINAL THIS AGREEMENT made and entered into this _tL day of January, 2018, by and between the City of Richmond, Indiana, a municipal corporation acting by and through its Board of Sanitary Commissioners (hereinafter referred to as the "City") and Smith Implements, Inc., 3421 W. State Road 38, Richmond, Indiana 47374 (hereinafter referred to as the "Contractor"). SECTION I. STATEMENT AND SUBJECT OF WORK City hereby agrees to purchase from Contractor two (2) new Diesel UTVs, with the specifics of the equipment being more specifically described in Exhibit `B", which is attached hereto and incorporated by reference herein. A Request for Quotes has been made available for inspection by Contractor, is on file in the office of the Department of Sanitation for the City of Richmond, Indiana, consisting of a total of three (3) typewritten pages, which are attached hereto and incorporated herein by reference as Exhibit "A". The response of Contractor to said Request for Quotes is attached hereto and incorporated by reference herein as Exhibit `B", consisting of eleven (11) typewritten pages. Should any provisions, terms, or conditions contained in any of the documents attached hereto as Exhibits, or in any of the documents incorporated by reference herein, conflict with any of the provisions, terms, or conditions of this Agreement, this Agreement shall be controlling. This Agreement shall not take effect until the City is in receipt of any required bonds and certificates of insurance, and until a purchase order has been issued by the Purchasing Department. SECTION II. STATUS OF CONTRACTOR Contractor shall be deemed to be an independent contractor and is not an employee or agent of the City of Richmond. SECTION III. PURCHASE PRICE City shall pay Contractor a sum not to exceed Thirty -Five Thousand Nine Dollars and Forty -Two Cents ($35,009.42) for the above described two (2) new diesel UTVs. Said amount includes all shipping, handling and delivery charges. The equipment is to be delivered to the Richmond Sanitary District Wastewater Treatment Plan, 2380 Liberty Avenue, Richmond, Indiana. The estimated delivery time for the above described equipment is thirty (30) days after the execution of this Purchase Agreement. Contract No. 4-2018 Page 1 of 3 SECTION IV. PROHIBITION AGAINST DISCRIMINATION Pursuant to Indiana Code 22-9-1-10, Contractor, any sub -contractor, or any person acting on behalf of Contractor or any sub -contractor shall not discriminate against any employee or applicant for employment to be employed in the performance of this Agreement, with respect to hire, tenure, terms, conditions or privileges of employment or any matter directly or indirectly related to employment, because of race, religion, color, sex, disability, national origin, or ancestry. SECTION V. MISCELLANEOUS This Agreement is personal to the parties hereto and neither party may assign or delegate any of its rights or obligations hereunder without the prior written consent of the other party. Any such delegation or assignment, without the prior written consent of the other party, shall be null and void. This Agreement shall be controlled by and interpreted according to Indiana law and shall be binding upon the parties, their successors and assigns. This document constitutes the entire Agreement between the parties, although it may be altered or amended in whole or in part at any time by filing with the Agreement a written instrument setting forth such changes signed by both parties. By executing this Agreement the parties agree that this document supersedes any previous discussion, negotiation, or conversation relating to the subject matter contained herein. This Agreement may be simultaneously executed in several counterparts, each of which shall be an original and all of which shall constitute but one and the same instrument. The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and any suit arising out of this Contract must be filed in said courts. The parties specifically agree that no arbitration or mediation shall be required prior to the commencement of legal proceedings in said Courts. By executing this Agreement, Contractor is estopped from bringing suit or any other action in any alternative forum, venue, or in front of any other tribunal, court, or administrative body other than the Circuit or Superior Courts of Wayne County, Indiana, regardless of any right Contractor may have to bring such suit in front of other tribunals or in other venues. Any person executing this Contract in a representative capacity hereby warrants that he/she has been duly authorized by his or her principal to execute this Contract. In the event of any breach of this Agreement by Contractor, and in addition to any remedies, Contractor shall be liable for costs incurred by City in its efforts to enforce this Agreement, including but not limited to, City's reasonable attorney's fees, to the proportionate extent that Contractor is determined to be in breach of this Agreement. In the event that an ambiguity, question of intent, or a need for interpretation of this Agreement arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption or burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any of the provisions of this Agreement. If any portion of this agreement is declared unenforceable by a comlor tribunal, all other portions shall remain in full force and effect. Page 2 of 3 IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of the day and year first written above, although signatures may be affixed on different dates. "CITY" "CONTRACTOR" THE CITY OF RICHMOND, INDIANA SMITH IMPLEMENTS, INC. by and through its Board of Sanitary Commissioners /f By: By: W Sue Miller, President Printed: �IVO% L cad Title: Ud Dated: ho u,y Aman Bakshi, Vice President reg Stfens, Member /M Dated: ( ! `JC9 APPROVED - now, or Dated: 01 (Z Page 3 of 3 PRICE REOUEST �o CW0FMCMQM THIS IS NOT AN ORDER VENDOR INSTRUCTIONS This Is a request fora prlds for the services of materials, described be low. Any additional -speofflaaffo ' na May be attached her6to. This Is NOT sit order and'thO C lose the right to .accept all or part, or decline the enti:11miraL Please complete your full nimb and phone number below with signature;IteNzo Oil" pfloes -and, crafgas where requested; and attach. any eipliknatlon.fk any substitution to optiptilogtibind altered. Return in sl'sskled stivellopb, In okra of Rlcihffkqn4 Sanitary 6jStrIqt;0oard of Commissioners to the administration b0ding at the ,address above by the specified date and time to be.consIdered. PLYMPPTPE.INl3Y' PAYMENTTERMS: I)EILIVERY.R9QUIRED: October 16,2017 1'Q'00 A.M. on Odtober-�4,2017 UPON RECEIPT OF INVOICE DELIVERED DESCRIPTION •Thls Is a request for quotes fbi purchasing two(2) 1017 012Lel UTVs. Sppelfications are enclosed. y requirements and indlana Local Preference Claims will apply to this . quote. AtIl E-Verif - Return the quote In a sealed envelope .addressed to. Richmond Sanitary District Denise. Johnson, Customer Svc Mrg 2396 Llborty Avenue Richmond, IN 47314 11o: Diesel.0TV's Please include Oil warranty InWiNaUdh With quote.. Arty questions, please call Jeff LOhMpelldt at 765-9037464. Quote Valid UnKI Cost Per Diesel UIV Total,puoted Cost NAME OF FIRM QUOTING: STATE TAX EXEMPTION #00312190M01 13Yi AUTHdfdWM 13Y GIGNATURE Richmond Sat ary District BATE PHO1gEWqM5r!;R I Specifications Por W two i017 Wiese] ITV fi . H is looking to purchase a UTV for jf&-quart ft to completeIcU The klchMond Sanitary prid, ersworkthAtis-dff .1 with a truck, Specs Cylinder 854ce Diesel engine Yes NO 38.3 ft. lbs. of Torque Yeg No EVUrphsmis9lon with.1-ligh, Low, Reverse Yes No 4 Wheel Drive Independent Suspension With &V of travel 2611 -All Terrain Tires Electric Power Steering Dual Disc Brakes(Front and Rear) 10.2" Ground Clearance 7 Gallon Fuel Capacity iOdo lb. cargo Bed Capacity Yes Yes Yes Yes Yes Yes Cargo 9.ed Power lift Yes Sqhting Occuponcy MlnlmuM of 2- Yes 1400 lbi ToWing Capacity Yes Odometer, -Hour rnefqt 'SpOdometer, Fuel Gauge,Yes Tilt Steering Wheel Yes 3 Yearfattory Warranty Ye§ DraW-Par Yes Side Mirrors -Yes Roof(poly) Yes Full Door Yes Glass Windshield (with Wipers) Yes No No No No No No No No No fVo No, NO No No No No Proposal Sheet Dealership Submitting Quote: Price Firm for How long Estimated Delivery (2) New 20V Diesel UN $ each $ Both Government Discounts $ Price After Disco unt $ Total Price for (2) NdW 2017 Diesel UTV ¢ Prices to Include all shipping, handling, delivery, pickup. and setup charges. Vehicle to be delivered to the Richmond Sanitary D'isttict WWTP, 2390 Liberty -Ave., Richmond, IN 47374 All questions shall be directed to Pat Smoker; PlantSuperintendent76SA960-0765 or Jeff Lohmoeller, Plant o Manager, 765=993-2670. Authorized Signature Date Contact Person Phone PRICE REQUEST WOVIACUMOND DEPOT�MUA N 0aWW=.=M4 A47374 THIS IS NOT AN ORDER -777-:77777777-' VENDOR INSTRUCTIONS This Is arequest fora price for the services of materials Sm6lmpleifteiita deandbed below. Arty additional specifications may be attached hereto. This Is KPT an order and thii City reserves 3421 West SX.38 the ht to accept all or pad, or daogne the enure prop6sat. Plaides cothplete your full name grid phone number below Richmond 47574 IN witti .4griqIqre,. .. Itombba gh p#qga apd obqrges where requested; and attach any explanation for any-substitutlon to sp6bIWbhs altered. Retuth In a sealed drIVW0A In cars of Rlcfirfigh'0 idnitdl DI9trI6fBoard '6f Commissioners to 'address the adminis6fi6ni Wid1hg at the above by the ppedRed data and, Umg to be constdqrea. DATE, REPLY MUST -BE IN P.Y: PAYMF44T TERMS: DELIVERY REQUIRED: I PctobsH6,2017 W00 AA on OcWhdf 24,2917 I UPON RECEIPT OF . INVOICE DELIVERED DESCRIPTION ,This Is a request for quotes for purchasIqg-kwdf2) 2o17 Diesel UT%P-.s. Specifications are enclosed, M E-Verify requirements and Indiana Local 0 n a Claims will apply to Oils quote. - Prefere. Return the quote In a sealed envelope addressed to'. Richinoffd Sanitary District Denise Johnson, Customer Svc ft M01 Liberty Avenue Richmond, IN 47974 Re: Diesel-d*6 Please incil' d all r -ty information 't Aquestions,please call Jeff I-ohmoeller at 705-983-7464. q e.. ware n 9YQq- ny- .� QUote Valid Unitl 'I, -16AW-Alvv f 'Cost Pet Uesdl UTV $, 1 L7,5 0.4 - Z/ Total Quoted Cost $-221F STATE TAX EXIEMPTON1 603121900-001 Richmohd piste $Nhitary IN (lot NAME-oz FlIRM'Oug-T-1 16 A0THoHj&o BysIONATURE J)hli, TITLE PAIP Numpg!l. Snecifications For (2) Two 2017 Ulesel UTV The Richmond Sanitary_ Landfill Is looking to purchase a UTV for tight -quarters work that Is difficult to complete with a truck: specs 3 Cylinder.854cc Dlesel engine Yes J No 38.S ft. lbs. of Torque Yes No. CVTTransolisslon With high, Low, Reverse Yes No 4 Wheel Drive Yes N No independentSuspension with.8.5.' of travel 26" All Terrain Tires Electric PoiWgrSteering Dual Dlsc Brakes(Front-and Rear) 10.2' Ground Clearance 7 Gallon Fuel Capacity Yes Yes Yes Yes J Yes Yes d 1000 lb. Cargo Bed Capacity Yes Cargo Bed Power Lift Yes Seating Occupancy Minimum of.2 Yes t% 150t) lb. Towing Capacity Yes Y Speedometer, Fuel Gauge, Odometer, Hour meter Yes M' Tilt.Steering Wheel Yes 3 Year Factory Warranty Draw Bar t Side M..irrors Roofer )VIAL Full Door Glass Windshield (with wipers) .Yes / Yes Y Yes 1/ Yes Yes 1i Yes No No No No No No No No No No No V No No No No No Proposal Sheet Dealership Submitfing,ttuote, &01000 Price Firm for How Long U Estimated Delivery 4 () kvo (2-) New 2617 Diesel UTV 50 10 each$ 4012,4,Both 1 Government Discounts Price After Discount -04Jf Tqtal Price for (2) New 2017 Diesel UTV Pelces,tolticlude all shipping, handling, delivery, pickup and setup charges. Vehicle to -be delivered to the Richmond Sanitary pistrict WWTP,,2.380 L.iberty Ave, Rlchih6rtd, 1N 47374 All questlt)ns sh4ll be directed to Pat SmOker, Plant Superintendent 765z960-0765 or Jeff Lohmoellerj Plant Manager, 765-993-2670. orlized Signature /7 .,rg&�r - — contact Person 711r, f/4/. S-109 /Pfib- 0. e . Quote Id: 16268638 ALL PURCHASE ORDERS MUST BE MADE OUT TO.(VENpOR): Deere & Company 2000 John Deere: Run Cary, NC 27513 FED ID: 38-2362580; DUNSM 607690989 Delivering Dealer: Andrew Coomes Smith Implements, Inc. 3421 West State Road 38 Richmond, IN 47374 '' IPJiPLNTS ALL PURCHASE ORDERS MUST BE SENT TO DELIVERING DEALER: Smith Implements; Inc. 3421 West State Road 38 R1ch'fAond,*1N 47:374 888-272 2521 glennapittman@smlthlMplements.com Prepared For: Richmond Sanitation Dept. glennapittman@smithimplernents.corri Proposal For: Quote Prepared By: Andrew Coomes andycoomes@smithimplements.com Date: 19 October2017 Offer Explres; 30 November 2017 j JOHN DEERS ALL PURCHASE ORDERS MUST BE MADE -OUT ALL. PURCHASE ORDERS MUST BE SENT TO.tNEND179): TO DELIVERING.DEALER: Deere & Company Smith Irdoldrierits, Inc. 2000 John Deere Run 34ZI .W.ect State Road 38 Cary, NO 27613 Richmon..d, IN 47:374 FED ID 36-2382680; DUN6#: 60 7690989 088 272 2521 glennapittma7i@smithimplements.com Quote. Summary Prepared For:. Delivering Dealer: Richmond SarlitatIor Dept Smith irnploMents, Inc. Andrew Coomes 60 N 6th St RichMonci, IN 47374 3421 West State Road 38 Business: 766-983 7450 Richmond,1N.47374 Phone: 888-2122621 _ andycoomes@smithimplemenis.com 'Quote 1D: 16268538 -Created On: 19 October 2017 Last Modified On: 19 October 2017 Expiration Date: 30 November 2017 Equipment Summary Suggested list Selling Price Qty Extended JOHN DEE.RE XUV$55M (MY10) $ 20,838,94 $17,60411 _X 1 = $17,604.71- Contract: IN Landscaping NJPAPiggyback 16370-(PG 3P) . Price Effective Date: October 19, 2017 JOHNDEEREXUV856M (MY18) $20,838.04 $1Z,604,71 X 1 = $17,604.71 Contract: IN Landscaping NJPA Piggyback 16370 (PG 3P) Price Effecilve Date: October 19, 2017 Equipment Total $ 36,009.42 Salesperson : X Quote Summary Equipment Total $ 360009.42 Trade In SubTotal $ 44,009.42 Est. Service $ 0.00 Agreetneitt.Tax _ Total $ 05,009.4.2 Balance Dire $ 35,pQ9.42 -It to Accepted By ; X •- IMPL@PdENTSelflng Equipment Quote, Id: 10258530 Customer Name: RICHMOND SANITATION DEPT ALL PURCHASE ORDERS MUST BE MADE OUT ALL PURCHASE ORDERS MUST BE SENT TO (VENDOR): TQ DELIVERING DEALER: Deere & Company Smith Implements, Inc. 2000 John Deere Run 8421 West State Road 38 Cary, C 2 N7613 Richmond, IN 47374 FED. ID: 36-2382580; DUNSP 60-7600989 888 272.-2521 glennapittman@smithimpiements.cam JOHN -MERE XUV855M (MY18) ►ntract: [N )_.andscaping NJPA Piggyback 18370 (PG 3P) Suggested List ica Effective Date; October 19, 2017 $ 20,838.94 Selling Price $17,504.71 * Price per item includes Fees and Non-contradt items Code Description Qty List Price Discount% Discount Contract Extended Amount Price Contract Price 5700M XW8551VI (MY18) 1 $14,489.00 16.00 .$ 2,319.84 1$12,179:16 $12,179.16 Standard Op_ tions - Par Unit _ 001A US/Canada 1 $. 0.00 16.00 $ 0.00 $ 0.00 $ 0.00 0505 Build To Order 1 $ 0.00 16.00 $ 0.00 $ 0.00 $ 0.00 1029 Yellow Steal Wheels TOKS 1 $ 41.00 16.00 $ 6.56 $ 34.44 $ 34.44 Hawk All Terrain Tire's 2006 Bench $eat - Yellow 1 $ 0.00. 16.00 $ 0.00 $ 0.00 $ 0.00 2500 Green and Yellow 1 $ 0.00. 16.00 .$ 0.00 $ 0:00 -$ 0.00 3000 Deluxe CargQ Box with 1 $ 6.00 18.00 $ 0.00 $ 0:00 $ 0.00 Paint; Brake, Tail and Reverse lights 3101 Cargo Box Power Lift 1 $ 849.00 Woo $135.64 $ 713.16 $ 713.16 4004 Deluxe Gab Frame/Including 1 $ 2,4.70.00 16.00 $ 395.20 $ 2,074.80 :$ 2;074.80 Roof, Windshield, Wiper, Electrical Kit and Rear. Window and Nets 4049 Less Black Roof 1 $ 0.00 16,00 $ 0.00 $ 0.00 $ 0.00 4099 Less Power arid Protection 1 $ 0.00 16.00 $ am $ 0.00 $ 0.00 4199 Paoicage Less Rear Package 1 $ 0.0.0 10.00 $ 0.00 $ 0:00 $ 0:00 4249 Less Front Brush -Guard 1 $ 0.00 16.00 $0.00 $ 0.00 $ 0:00 Standard Opfiotis Total $ 3,36.0.00 $ 637.00 $ 2,822.40 $ 2,822.40 Dealer AttachmentslNon-Contract/OPen Market BM25445 Deluxe Close -Off Panel for 1 $ .311.37 16.00 $ 49.82 $ 261.65 $ 261.55 Poly or Gloss DoizrS BM24560 Glass Door Kit-- Deluxe Cab 1 $ 2,480.81 16.00 $ 398.21 $ 2,090.60 .$ 2,090:60 BM22290 Drawbar- $1 mm (2-in.) 1 $ 41.73 16.00 $ 6.68 $ 3545 $ 35.05 BM23609 Side Mirrors - Deluxe Oab 1 $138.03 16.00 $ 22.68 $ 115.95 $115.95 Dealer Attachments Total $ 2,97.9.04 $ 476.79 .$ 2,503.15 $ 2,$63.15 n JOHN MERE Selling Equipment Quote Id: 16258638 Customer Name: RICHMOND,SANITATION DEPT IMPLTH EMENTS ALL. PURCHASE ORDERS MUST BE MADE OUT ALL. PURCHASE ORPM. 8 MUST Eiji SENT TO (VENDOR): To bELIVERING DEAIIR: Deere & C6mpany 2000 John .Deere Run Smlth implements, Inc. 3421 West State Road 38 Cary; NC 27513 Richmond; IN 47374 FED ID: --36-2382580; DUNSM 60-7690989 888 272-2621. glennapitttman_@smithimptements.com Value Added Services $ 0.00 $ 0.06 $ 0.00 Total suagested Price $17;504.71. JOHN DFEERE.MV855M (MY18) act: IN Landscaping NJPA Piggyback 18370-(PG 3P) suggested List* Mao Date: Qctol r 19, 2017 $ 20,838.94 Selling Price " $17;504.71 Price per item - includes Fees and Non -contract items e 'Description Qty. List Price Discount°/a Discount Contract Extended Amount Price Contract Price 57DOM XUV655M (MY18) 1 $ .14,499,00 16.00 $ 2,319.84 4)'12.119-16 :$12,179.16 _ Standard Options - Per -Unit - 001A US/Canada 1 $ 0.00 16.00 $ 0.00 $ 0.00 $ 0.00 0505 BUIId To Order 1 $ 0.00 16A $.0.00 $ 0:00 $ 0.00 1029. Yellow Steel Wheels. Terra 1 $ 41.00 16.00 $ 8.5$ $ 34A4 :$:34.44 20QB Hawk All Terrain Tires Bench Beat L Yellow 1 $ 0.06 16.00 $ 0.00 $ 0.00 $. 0.00 2500 Green and Yellow 1 $ 0.00 16.00 $ 0,00 $ 0.00 $ 0.00 3000 Deluxe Cargo BoX with 1 $ 0.0.0 10.00 $ 0100 $ 0.00 $ 0.00 Paint, Brake, Tail sand ReVerse lights 3101 Cargo Box Power Lift 1 $ 849.00 4004 Oeluxe Gab Frame/Including 1 $ 2,470.00 Roof, Windshield, WOW, Electrical Kit and Rear Window And • nets 4040 Less P!.aek•Roof 1 $ 0.00 4099 Less Power and Protection 1 $ 0.00 Paokoge 4199 Less Rear Package 1 $ 0.00 4240 Less: Front.Brush•Guard 1 $ 0.00 Standard Options Total $.M60.00 16.00 $.135:84 $ 713.16 $ 713,10 16.00 $ $95.20 $ 2,074.80 $ 4074,80 16.0.0 $ 0.00 16.00 $ 040 '16.00 $ 0100 16.00 $ 0.00 $.537.60 a.ti0 $ 0.00 $_ b.00 $ 0.00 0.00 $ O.bO $.0,00 $ 0.00 p2.40 $ 2;$22A() �.kln,L t3.L� JOHN DEERIF IMPLEMENTS Sell ing,Equ i pment Quote Id: 16268538 Custojmdr Namo: RICHMOND SANITATION DEPT ALL PURCHASE ORDERS MUST BE MADE OUT ALL PURCHASE ORDERS MUST BE SENT To (VENDOR): TO DEUVER(N.r. DEALER: - Deere & Company Smith lrhplements, Inc. 3421 West Stale Road 88 2000 John Deer& Run Cary, NG 27513 'ki6mond, IN 47374 FED lb: 36-2382680; D.UN,S#-.t 607690989 888!-272-;2521 , glennapittm6n@srnithlmpleme-nts.com - B - M25445- Deluxe Close -.Off Panel for 1 $311.37 Poly or Q)ass Doors dM24660 Glass Door Kit - Deluxe Cab .1 $ 2,488.81 W22290 Drawbar 51 mrp (2 in.) 1 $41.7-3 BM23508 Sfde.Mltrors-- Deluxe Cab 1 $138.03 Dealer Attachments Total $2,979.94 Vaiu'e Added services 0.00 total 16. , 00 $49.82 $261.56 $261.55 16.00 $398..21 $2,090.60- $2,090-60 16.00 $'6.68 $ 35405 $ 36.05- '16.00 $22-.08 '$115.96. $416.95 $476.76 $.1j603.16 $2,603.16 $0.00 $0.00 $-i7,604JI ROST DIOD MUMMAL Local Indisma.Dmkois Fr&mice Pursout-to the City of RidWond Bidding tad Contract Requirements, this application p ti� x p nfo *e1ocal. Indiana businnpg,pursqant to hdiana code section s-22-15-2o.9, is hereby submitted for the project Rated below by Bidder/Applicant (hereinafter Bidder). (Tise add(tioiW sheets if necessary,) Date Bld.gubmittad: Or ,pWNt ADIJ ProjeotNumber: PToleptName: IN7 IU8-SaL U wt Bidder. P(Mtq4W?,Ao_'. Amy Ommir,-Z Phone Number: AS-1 9/_L/ - S34 Principal iorl� P1406 of Business: Gree)I�;WIL WQIM Number of Montbs Aftess has been hinoipal Place of Business: A Veaves Number of all Employees for thetwelve, (12) months prior to the da6 of K4 submission: Number of Rkployeev Who were residents of Affected Counties for 1hetwelve (12) months prior to the date of Bide submIssion- 1. lfthe-Biddw claims it is a.local,.1affiana. business because the Blddex'g principal place of business is in Wayne County or an adjacent counfh- give aatat=ent explaioing the reasons the business considers tote location named as the business's principal place of business: 2. In order to claim, local preference pursuant to Iiidiana Code section 522-1520.9, ft Bidder must supply belowits total payroll and the amount of the bus11 moss s payroll paid ftesidents of Affected Counties for te previous twelve (12) months from the date of the Did. a. Total Amount of payroll paid' to all employees Oh'Biddex in the previous twelve (12) monffis -A-cm the dgio of the BA.- b. ToWAmouutofpayxoll_paidtoxeside-utsofaffertod.counti ps for the,,vevious twelve (12) monifisfiom the date of the Bid: Bidder shall supply suppoffingpaytolt xecards sufficient for Owner to eStablishthe above xepesentationi: bt4 INDIANA 140CAL PAUL, AMM, CLAM (Only fill out this Part .ff claiming to be aLocal 1ludioaBusiness) Pursuant to Indiana. Code 5-22-15-20.9,(" I (Name of Business) qaimp aJocal Thdiana business Nefermee hr the W for PxoJW —1 tf i ; L UTV'� in Wayne County, Indiana. 6 am of Pr6ject) 0 The Claim of -applicability of the LpealIndiana Business preftence-isbased. up.onthebllov4ng (Check all that apply) )< 1. The location of the Business's *incipalplaae of business is: ,A.) in Wayne County, or B) in an adjacent county -11 2; The m4oAty of the businaBB's.-payroll, for the previous twelve (12) :on onth.s from the date of this RA is to xesidlents in Wayne:oran adjacent county. 0 3. The majority of he business's employce's, for. the previous twelve (12) months fiom the dato of ifils; Bid, at residents of Wayne of an adjacent coilhbr. If business is deemed to b e the apparontlow bidder, business Bhall.provl4e infoi:mation pursuant to PosOid submittal (Localhd1waBuAAess Preference), to substantiate the claim da local Indiana business. I Affidavit of Rmployinett Eligibility Venfication. The Contractor, & IE44 �9� IX afflaids under -&o penatW of peiftu that. Centro ctox floes i%t knowingly OMP16Y 04 -QnaAjhqjdzed alien. If Contractor is self employed and does not @Mploy any employees, Contractor vexes he or she is -a United States citizen or. .qualified alien. The Contacmr has not Imbwiwjy employed or contracted -%ft an unauthorized ahMAn4 riot rotwn AA employee or contract with. 9, posw that tho Qattmotor subsequently leams is, an mauthwiwd alien. Pursuant to Indiana Code 22-5-1.7, Contractor has enrolled verified In 4 ve ed theworkp4gibRystafaspf One*y-hired employees ofthp qaptractortbrorqghtheludia=B- Vmif3rprogram, The C.Ontrabtor has requited Contractor's subcontrotors to certify to the - Confradtor that the subcontractor does not knowingly employ or contract with an una�uihorized alien and that the subcontractor has enrolled and is pmikipating -k tho E-Verify program The Contractor WM znaintaim Ibis ceAtificafton tkoughout the duration ofIhe term of a contract with a siftcrattactox I hexeby verify under the penalty of Pqjwy that ihe foregoing statement is true. Dated tbi.s day of P2017-