Appendix F-2 CMS_FINAL 090524_Non-Profit Diversity Report Form.xlsx
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- Solicitation number
- 21240625164751
- Issued by
- Philadelphia County, Dale Borough, Pennsylvania
About this file
This is a Non-Profit Diversity Report Form (Appendix F-2) issued by the City of Philadelphia's Office of Economic Opportunity in response to Executive Order 03-12, applicable to nonprofit applicants responding to the Philadelphia Department of Aviation's Digital Content Management System Support contract opportunity. Nonprofit applicants are required to submit demographic information about their workforce and board composition, including breakdowns by race, ethnicity, gender, and disability status. Additionally, applicants must provide documentation of their supplier diversity policies and identify their five highest dollar value minority, woman, and disabled-owned business enterprise (M/W/DSBE) suppliers with corresponding annual expenditure amounts. The form requests a policy statement explaining the nonprofit's efforts to maintain workforce diversity, board diversity, and operate an effective supplier diversity program. Applicants may submit this information with their proposals, though the City retains discretion to allow submission or amendment at any time prior to award.
The form serves as a compliance document requiring detailed demographic data collection across workforce and governance structures, with particular emphasis on diversity and inclusion metrics. Completion and submission of this appendix is mandatory for nonprofit organizations bidding on City of Philadelphia contracts, supporting the City's diversity objectives and supplier diversity program requirements. No specific pricing terms, funding amounts, or contract duration information is contained within this diversity reporting form itself.
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INSTRUCTIONS
| APPENDIX F (F-2) |
| Executive Order 01-21 |
| Instructions for Nonprofit Applicants |
In response to the objectives of Executive Order 03-12, nonprofit applicants are required to submit the following information to the Office of Economic Opportunity (OEO):
1 Identification of the race, gender, disability status, and ethnic composition of the nonprofit’s workforce; and
2 Identification of the race, gender, disability status, and ethnic composition of the nonprofit’s board of directors or trustees; and
3 The nonprofit’s policy statement explaining its efforts to maintain a diverse workforce, a diverse board of directors and operate a fair and effective supplier diversity program; and
4 Identification of the nonprofit’s five highest dollar value M/W/DSBE suppliers of products and services.
Please use the attached form to submit this information, attaching additional pages as needed. This information should be submitted with the applicant’s proposal, but the City, at its sole discretion, may allow applicants to submit or amend this form at any time prior to award.
NON-PROFIT APPLICATION
| 1 | DEMOGRAPHIC BREAKDOWN OF WORKFORCE | ||||||
| Please provide the following demographic breakdown of your workforce by race/ethnicity/gender/disability: | # | % | % | % | |||
| African American | Males | ||||||
| Asian/Pacific Islander | Females | ||||||
| Caucasian | |||||||
| Disabled | |||||||
| Hispanic | |||||||
| Native American | |||||||
| Other | |||||||
| Total Number of Employees | |||||||
| 2 | DEMOGRAPHIC BREAKDOWN OF BOARD COMPOSITION | ||||||
| Please provide the following demographic breakdown of your Board of Directors or Trustees by race/ethnicity/gender/disability: | |||||||
| African American | # | % | # | % | |||
| Asian/Pacific Islander | Males | ||||||
| Caucasian | Females | ||||||
| Disabled | |||||||
| Hispanic | |||||||
| Native American | |||||||
| Other | |||||||
| Total Number of Directors or Trustees | |||||||
| 3 | SUPPLIER DIVERSITY | ||||||
| Please check the appropriate box to indicate if you have a supplier diversity policy. If "no,"please explain on your letterhead. | Yes | No |
If you maintain a supplier diversity policy, please attach a copy of your supplier diversity policy.
Please identify below, your agency's five (5) highest minority, woman, and/or disabled owned business suppliers of products or services, indicating your estimated annual expenditure(s) with the firm:
Company Name Company Address Company Telephone Minority Woman Disabled Annual Expenditures
| 1 | |||
| 2 | |||
| 3 | |||
| 4 | |||
| 5 | |||
| Signature: | Date: | Non-Profit Name |
&"Arial,Bold"&14City of Philadelphia - Office of Economic Opportunity Diversity Report of Nonprofit Organizations
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