FY 25 LGBTQ_Applicant_Data_Form~75.pdf
PDF 2 MB Posted
- Attached to
- Safety Blanket & Smock - Suicide/Isolation
- Solicitation number
- B2727416
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department as part of a micro purchase opportunity for Safety Blanket & Smock products related to suicide and isolation prevention. The form is designed to collect voluntary demographic data from applicants to identify Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) businesses interested in doing business with the City. The procurement opportunity allows awards to be made either in whole or by line item, whichever serves the City's best interest, with selection based on the lowest responsive and responsible bidder. All applicants must quote all items to be eligible for award, and delivery or service provision should not commence until official notification is received from the designated department.
The form requests information regarding beneficial ownership and control by LGBTQ individuals, current certification status through the National LGBT Chamber of Commerce (NGLCC) via the Philadelphia-based Independence Business Alliance (IBA), and any additional third-party certifications such as those from the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, Disability:IN, or Women's Business Enterprise National Council. Applicants are also asked to identify any certified LGBTBE subcontractors involved in the contract performance. The City has indicated that submitted data may be used for other projects and potentially made publicly available, though participation in the data collection is entirely voluntary and does not affect bid consideration or award eligibility.
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Other files
| File | Type | Posted |
|---|---|---|
| Contracts Consent Agreement~50.pdf | ||
| Small Purchase Checklist~89.pdf | ||
| FY 27 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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