FY-27 LGBTQ_Applicant_Data_Form B2626749.pdf
PDF 2 MB Posted
- Attached to
- Accent Opaque/ Cougar
- Solicitation number
- B2727694
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia Procurement Department as part of a voluntary diversity, equity, and inclusion initiative for state and local contracting opportunities in Pennsylvania. The form collects information from applicants regarding their business ownership and certification status to identify LGBTQ-owned businesses interested in conducting business with the City. The form requests applicants to disclose whether their business is beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and whether the business holds current certification as an LGBTBE through the National LGBT Chamber of Commerce or its Philadelphia affiliate, the Independence Business Alliance. Additionally, applicants must identify any subcontractors certified as LGBTBE and provide information regarding third-party certifications from organizations such as the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, Disability:IN, or Women's Business Enterprise National Council.
The City of Philadelphia uses the data collected through this form to develop and maintain an accurate inventory of LGBTQ businesses within its vendor database and to inform future diversity and inclusion efforts in City procurement activities. Submission of the form is entirely voluntary, and applicants authorize the City to use the submitted data for other projects and to make such data publicly available at the City's discretion. The form applies to contract opportunities such as the Accent Opaque/Cougar small order purchase, which will be awarded to the lowest responsive bidder on a whole or line-item basis contingent upon the seller quoting all items.
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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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