LGBTQ_Applicant_Data_Form_~4.pdf
PDF 2 MB Posted
- Attached to
- Maintenance for BQ50 machines
- Solicitation number
- B2627036
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form used by the City of Philadelphia's procurement department to collect diversity and inclusion information from bidders on municipal contract opportunities. The form is designed to identify companies beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ) that wish to conduct business with the City. The specific contract opportunity referenced is a micro purchase for maintenance services related to BQ50 machines. Applicants are required to quote all items to be eligible for award, with the contract to be awarded as a whole or by line item, whichever serves the City's best interest, to the lowest responsive and responsible bidder. No delivery or services are to commence until notification is received from the City department.
The data collection form is entirely voluntary and serves to populate the City's vendor database with LGBTQ-certified businesses while informing future diversity and inclusion initiatives in municipal procurement. The form requests information regarding current LGBTQ Business Enterprise (LGBTBE) certification by the National LGBT Chamber of Commerce through its Philadelphia affiliate, the Independence Business Alliance (IBA), as well as any additional third-party certifications such as minority, women's, and disability business enterprise designations. Applicants are also asked to identify any subcontractors holding LGBTBE certification. The City of Philadelphia reserves the right to use submitted data for other projects and may make it publicly available as part of its commitment to diversity, equity, and inclusion in all procurement activities.
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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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