FY-27 LGBTQ_Applicant_Data_Form B2728329.pdf
PDF 2 MB Posted
- Attached to
- Blu-Ray DVD Player
- Solicitation number
- B2728329
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form for the City of Philadelphia's procurement process, designed to collect diversity and inclusion information from businesses seeking contracts with the City. The form functions as a voluntary data collection instrument for identifying and tracking lesbian, gay, bisexual, transgender, and queer (LGBTQ)-owned businesses interested in doing business with Philadelphia. The form requests information regarding beneficial ownership and control by LGBTQ persons, current LGBTQ Business Enterprise (LGBTBE) certification status through the National LGBT Chamber of Commerce (NGLCC) or its Philadelphia affiliate, the Independence Business Alliance (IBA), and identification of any LGBTQ-certified subcontractors. The specific contracting opportunity associated with this form is a micro purchase for a Blu-Ray DVD Player in Pennsylvania, to be awarded as a whole or by line item to the lowest responsive and responsible bidder.
The City of Philadelphia has indicated that submission of this form is entirely voluntary and that the data collected may be used for other projects and potentially made publicly available at the City's discretion. The form also inquires whether applicants hold certifications from other third-party certifying agencies such as the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or the Women's Business Enterprise National Council (WBENC). The micro purchase requirement specifies that all items must be quoted to be eligible for award consideration, and no delivery or services are to be provided until official notification is received from the requesting department.
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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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