B2728262 LGBTQ Applicant form.pdf
PDF 2 MB Posted
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- inks for Canon Image Prograf TM300
- Solicitation number
- B2728262
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Opportunity Data Form issued by the City of Philadelphia's Procurement Department. The form is designed to collect voluntary information from applicants and bidders regarding LGBTQ business ownership and certification status. The City uses this data to identify and track the number of LGBTQ-owned businesses currently doing business with the City and to facilitate the inclusion of certified LGBTQ businesses into the City's vendor database. The form requests applicant and bid/opportunity identification information and inquires whether the applicant's business is beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer.
The form collects information regarding current LGBTQ Business Enterprise (LGBTBE) certification status through the National LGBT Chamber of Commerce (NGLCC) or its local Philadelphia affiliate, the Independence Business Alliance (IBA). It also requests details about any additional third-party certifications held by the applicant, such as those from the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC), including the specific certification category. The form further inquires whether any subcontractors associated with the contracting opportunity are LGBTBE certified and requests a complete listing of such certified subcontractors by business name. Submission of the form is entirely voluntary, and by submitting the form, applicants agree that the City may use the submitted data for other projects and may make it publicly available.
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Other files
| File | Type | Posted |
|---|---|---|
| consent and authorization B2728262.pdf | ||
| B2728262 Seller Checklist.pdf | ||
| B2728262 Micro Purchase Terms and Conditions.pdf |
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Text version
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 of Philadelphia’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.
By submitting this form you are agreeing that the City may, in its discretion, use the data submitted for other projects and may cause it to become publicly available.
Response to this form is entirely voluntary.
Applicant Name:
Bid or Opportunity #:
LGBTQ Applicant Opportunity DataLGBTQ Applicant Opportunity Data
CCIITTY Y OF OF PHIPHILALADDELPHELPHIIA
1401 JFJFK K BBllvvdd. . RoRooom m 117700B B - - PhPhiillaaddeellpphhiiaa, , PA PA 1199110022--11668855 www.phila.gov/procurement
| 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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