B2626774 LGBTQ Applicant Data Form.pdf
PDF 2 MB Posted
- Attached to
- HeatSeal Thermal Laminator
- Solicitation number
- B2626774
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Opportunity Data Form used by the City of Philadelphia to collect voluntary demographic information from businesses bidding on city contracts. The form is designed to identify companies beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer and to support the city's commitment to diversity, equity, and inclusion in procurement activities. The specific contract opportunity referenced is a micro purchase for a HeatSeal Thermal Laminator in Pennsylvania, to be awarded as a whole or by line item to the lowest responsive and responsible bidder, with the requirement that sellers quote all items to be eligible for award.
The form requests information regarding LGBTQ business certification status, including whether the applicant's business is certified as an LGBTBE by the National LGBT Chamber of Commerce through the Independence Business Alliance, any additional third-party certifications held, and the involvement of LGBTQ-certified subcontractors. Response to the data collection form is voluntary and is intended to build the city's vendor database while tracking the number of LGBTQ-owned businesses currently conducting business with Philadelphia. No delivery or services are to commence until official notification is received from the purchasing department.
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Other files
| File | Type | Posted |
|---|---|---|
| Seller_SOP_Checklist B2626774.pdf | ||
| Consent_Authorization B2626774.pdf | ||
| B2626774 Micro Purchase Terms and Conditions.pdf |
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Text version
LGBTQ Applicant Opportunity Data
1. Is Applicant’s business beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender or Queer?
2. Is Applicant’s business currently certified as a Lesbian, Gay, Bisexual, Transgender, Business Enterprise (LGBTBE) by the National LGBT Chamber of Commerce (NGLCC) through their local Philadelphia affiliate, the Independence Business Alliance (IBA)?
a. If yes, Applicant is currently certified by NGLCC/IBA as an LGBTBE, is Applicant's business also certified by any other third party certifying agency such as Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN or Women's Business Enterprise National Council (WBENC)?
If yes please identify the name of the certifying agency and category of certification (e.g., MBE, WBE, DSBE, DBE):
Certifying Agency Certification Category
3. For this contracting opportunity, are any of Applicant’s subcontractors certified by NGLCC/IBA? If yes, how many subcontractors are certified as LGBTBE?
Please list all by business name below.
As part of the City’s commitment to diversity, equity and inclusion in all aspects of City procurement, the City is collecting data to identify the number of companies beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender and Queer persons who wish to do business with the City (collectively, “LGBTQ businesses”). The data will be used to identify the number of LGBTQ businesses currently doing business with the City. It will also assist in efforts to include LGBTQ certified businesses into the City’s vendor database. Response to this form is voluntary.
Applicant Name
Bid or Opportunity #
| CertifiedLGBTEYes: Y |
| CertifiedLGBTENo: N |
| Certification: |
| LGBTQTypeYes: Y |
| LGBTQTypeNo: N |
| CertifiedNGLCCNo: N |
| CertifiedNGLCCYes: Y |
| LGBTQTypeY: Off |
| LGBTQTypeN: Off |
| CertifiedLGBTEY: Off |
| CertifiedLGBTEN: Off |
| CertifiedNGLCCY: Off |
| CertifiedNGLCCN: Off |
| Subconsultants: |
| BusinessName3: |
| BusinessName4: |
| BusinessName5: |
| Reset: |
| btnContinue: |
| CertifyingAgency: |
| BusinessName: |
| BusinessName2: |
| ApplicantName: |
| BidNumber: |
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