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County of Riverside Request for Quote # PUARC -1200 Purchasing & Fleet Services Closing Date: 1011112011(g,1:30 P.M. Local Business Qualification Affidavit The County of Riverside Local Business Preference may be applied to this Request for Proposal /Quotation. If you qualify for this preference, please submit this form along with your response to this RFP /Q. Definition of Local Business A local business shall mean a business or firm with fixed offices located within the geographical boundaries of Riverside County, and authorized to perform business within the County. in doing so, credit all sales tax from sales generated within Riverside County to the County, and who provide product or perform contracted work using employees, of whom the majority are physically located in said local offices. Local businesses" shall have a Riverside County business street address. Post office box numbers, residential addresses, or un- staffed sales offices shall not suffice to establish status as a 'local business." To qualify as a 'local business" the location must be open and staffed during normal business hours and the business must establish proof that it has been located and doing business in Riverside County for at least (6) six months preceding its certification to the County as a local business. Additional supporting documentation that may be requested by the County to verify qualification includes; 1. A copy of their current BOE 531 -A and/or BIDE 530 -C form (State, Local & District Sales, and Use Tax Return Form). This is what businesses submit to the State Board of Equalization when paying the sales tax to the State of California indicating the amount of the payment to be credited to each jurisdiction (i.e, Counties, Cities). 2. A current business license if required for the political jurisdiction the business is located. 3. Proof of the current business address. The local business needs to be operating from a functional office that is staffed with the company's employees during normal business hours. Business Name: Physical Address: Phone: Length of time at this location: If less than 6 month, list previous Riverside County location: Business License # (where applicable): Hours of Operation: FAX: E -Mail: Number of Company Employees at this address: Primary function of this location (i.e., sales, distribution, production, corporate, etc): Signauare of Company Official Print Name, Title Date Submittal of false data will result in disqualification of local preference and /or doing business with the Riverside County. Form # 116 -260 Rev 8104 Form # 116 -1.01 RFQ Public Purchase Revision 0411.2/11