Att G - Purchasing Preference Form.docx

Attachment G

CLAIMING PURCHASING PREFERENCES

Each bidder should review the various procurement preferences allowed by State statute. A summary of the preferences can be under Programs and Preferences located at: https://www.in.gov/idoa/3106.htm.

Each bidder must answer the following questions pertaining to purchasing preferences. No preference will be applied unless these questions have been answered and any required attachments included.

1. Are you claiming the U.S. Manufactured Product Preference (IC 5-22-15-21) Yes _____ No _____ This is per individual line and should be noted below Vendor must provide information at the individual line level in regard to this preference...If yes, the bidder is certifying under penalties of perjury that each of the bidder’s end products, except those listed under the Exceptions section, is a U.S.

Manufactured Product as described in IC 5-22-15-21. A product is manufactured in the United States, if the cost of its components mined, produced, or manufactured in the United States exceeds 50% of the cost of all its components. (In determining if a product is manufactured in the United States, only the product and its components shall be considered.)

Please list what line items this preference will apply to:

2. Are you claiming the Preference for Steel Products (IC 5-22-15-25) Yes ___ No ___

3. Are you claiming the Preference to Coal Mined in Indiana (IC 5-22-15-22) Yes ___ No ___

4. Are you claiming the Indiana Business (Buy Indiana) Preference (IC 5-22-15-20.5) Yes ___ No ___ Indicate under which provision for which you are claiming to qualify as an Indiana business, fully complete the Indiana Economic Impact Form (State Form # 51778 and include it with your bid/proposal. Vendors who wish to claim one of the Buy Indiana preferences below, must register from https://www.in.gov/idoa/2467.htm. Click on the Supplier Portal Login link, to register and/or update an existing registration. Indicate interest in learning if the business qualifies for Buy Indiana. Upon answering YES, look for more information via email. Respondents may only select one category as shown below. Indicate your selection by clicking the check box next to the certification paragraph. Supporting documents may be required. They should be uploaded so the certification team can review. Once this is complete, save your selection and exit your account.

Approval will be documented by a system generated notification sent to the point of contact email address provided within the Bidder Registration profile. This is to be attached as a screenshot (copied/pasted) for response evaluation. If this document cannot be provided, affirm Buy IN status in a letter, on company letterhead. Provide sufficient detail so the State can confirm approval of the entity. Buy IN must be affirmatively claimed and documentation submitted per the instructions _____ (1) A business whose principal place of business is located in Indiana.

_____ (2) A business that pays a majority of its payroll (in dollar volume) to residents of Indiana.

_____ (3) A business that employs Indiana residents as a majority of its employees.

_____ (4) A business that makes significant capital investments in Indiana.

Any company that can demonstrate a minimum capital investment of $5 million or more in plant and/or equipment or annual lease payments of $2.5 million or more shall qualifies as an Indiana business under category #4.

_____ (5) A business that has a substantial positive economic impact on Indiana Any company that is in the top 500 companies (adjusted) for one of the following categories: number of employees (DWD), unemployment taxes (DWD), payroll withholding taxes (DOR), or Corporate Income Taxes (DOR); qualifies as an Indiana business under category #5.

5. Are you claiming the Indiana Manufactured Preference (IC 5-22-15-20.5) Yes ___ No ___ This preference may only be claimed by respondents who claim the Indiana Business Preference.

Submit necessary documentation detailing a substantial amount of manufacturing, assembly, or production of the products proposed is in the State of Indiana.

6. Are you claiming the preference for supplies that contain recycled or post-consumer materials (IC 5-22-15-16) Yes ___ No ___

The preference does not apply when the purchase description is limited to a supply that contains recycled materials or post-consumer materials If yes, a manufacturer’s certification must be submitted for each item or group of items for which the offeror is seeking a preference, or the preference may not be considered.

CLAIMING PURCHASING PREFERENCES

1. Are you claiming the preference for soybean oil-based ink (IC 5-22-15-18) Yes ___ No ___

2. Are you claiming the preference for soy diesel/bio diesel (IC 5-22-15-19) Yes ___ No ___

3. Are you claiming the Indiana Small Business Preference (IC 5-22-15-23) Yes ___ No ___ If yes, bidder must indicate which category of small business concern applies:

___Wholesale business with annual sales of four million dollars ($4,000,000) or less during its last fiscal year. “Wholesale business means a business that derives its principal source of income (over 50% of gross revenues) from sales to retailers, other merchants, or industrial, institutional or commercial users who will use the goods for resale or business use. This definition distribution activities ___Service business with average sales of five hundred thousand dollars ($500,000) or less for the current and preceding three (3) fiscal years and which employs no more than twenty-five (25) persons. “Service business, “means a business that derives its principal source of income (over 50% of gross revenues) from the sale of useful artistic, educational, intellectual, literary, or scientific labor from which no necessary tangible commodity is derived.

___Retail business or business selling services with annual sales and receipts of five hundred thousand dollars ($500,000) or less. “Retail business,” means a business that derives its principal source of income (over 50% of gross revenues) from the sale of supplies to the ultimate consumer.

___Manufacturing business, which employs no more than one hundred (100) persons. “Manufacturing business” means a business that derives its principal source of income (over 50% of gross revenues) from the sale of goods the firm produces at its own facility made from raw, unfinished materials, as distinguished from the final product.

___A business in any of the following sectors is not a small business if its employees more than one hundred (100) persons or if its annual sales exceed 5 million dollars ($5,000,000):

(A) Information Technology

(B) Life Sciences

(C) Transportation

(D) Logistics ___A business that has a current verification as a veteran owned small business as defined by IC 5-22-14-3.5(a) (1-3).

1. Are you claiming the preference for Indiana farm products (IC 5-22-15-23.5) Yes ___ No ___

2. Are you claiming the preference for foods/beverages that contain high levels of calcium (IC 5-22-15-24) Yes ___ No __

Are you claiming the preference for Businesses providing specialized employee services (IC 5-22-15-26)?

Yes ___ No __ If yes, submit the completed Affidavit of Eligibility with solicitation response.