LGBTQ_Applicant_Data_Form_B1801234~13.pdf

PDF 2 MB Posted

Attached to
Hammer Tacker State and local contract opportunity
Solicitation number
B2627188
Issued by
Pennsylvania

About this file

This is an LGBTQ Applicant Opportunity Data Form used by the City of Philadelphia to collect diversity and inclusion information from bidders on municipal contracts. The form is administered in conjunction with the National LGBT Chamber of Commerce (NGLCC) through their local Philadelphia affiliate, the Independence Business Alliance (IBA), and may also involve third-party certifying agencies including the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, and the Women's Business Enterprise National Council (WBENC). Applicants are asked to provide their company name, bid or opportunity number, and respond to a series of questions regarding LGBTQ ownership and certification status. The form does not specify particular products, services, quantities, response dates, or contract terms, as it functions as a voluntary supplemental data collection tool rather than a standalone solicitation document.

The form is designed to gather information on LGBTQ-owned businesses currently doing business with the City and to assist in expanding the inclusion of LGBTQ certified enterprises in the City's vendor database as part of its commitment to diversity, equity, and inclusion in procurement. Applicants are asked to identify whether their business is beneficially owned and controlled by persons who self-identify as LGBTQ, whether they hold current LGBTBE certification, and whether any of their subcontractors are LGBTQ certified. Response to the form is entirely voluntary, and the data collected will be used for identification and outreach purposes only. No specific pricing terms, contract amounts, funding sources, or incumbent information are addressed in this form, as it serves solely as a data collection mechanism accompanying larger contracting opportunities.

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Consent_Authorization_B1801234~14.pdf PDF
MP_Terms_and_conditions_B1801234.pdf PDF
Seller_SP_Checklist_B1801234~7.pdf PDF

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Text version

LGBTQ Applicant Opportunity Data

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’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. Response to this form is voluntary.

Applicant Name

Bid or Opportunity #

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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