LGBTQ_Applicant_Data_Form_B1801234~24.pdf
PDF 2 MB Posted
- Attached to
- Bolt Cutters
- Solicitation number
- B2727842
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Opportunity Data Form used by the City of Philadelphia to collect diversity information from bidders on state and local contract opportunities. The form is designed to identify companies beneficially owned and controlled by persons 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 Bolt Cutters in Pennsylvania, to be awarded as a whole or by line item to the lowest responsive and responsible bidder. Applicants must quote all items to be eligible for award, and no delivery or services may commence until official notification is provided by the department.
The form requests voluntary disclosure regarding LGBTQ business ownership and certification status, including current certification by the National LGBT Chamber of Commerce (NGLCC) through the Philadelphia affiliate Independence Business Alliance (IBA), as well as any additional third-party certifications such as those from the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC). The form also requests identification of any certified LGBTBE subcontractors. The City's data collection effort is part of a broader commitment to diversity, equity, and inclusion in procurement and is intended to enhance outreach to LGBTQ-owned businesses for inclusion in the City's vendor database.
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Other files
| File | Type | Posted |
|---|---|---|
| MP_Terms_and_Conditions_B1801234~16.pdf | ||
| Seller_SP_Checklist_B1801234~20.pdf | ||
| Consent_Authorization_B1801234~25.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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