LGBTQ_Applicant_Data_Form_B1801234~25.pdf
PDF 2 MB Posted
- Attached to
- Plastic Bins
- Solicitation number
- B2727850
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form related to a plastic bins micro purchase opportunity in Pennsylvania. The document serves as a certification and demographic information collection form for applicants bidding on this procurement. The micro purchase will be awarded as a whole or by line item, whichever is in the best interest of the City, to the lowest responsive and responsible bidder. All sellers must quote all items to be eligible for award, and no delivery or services should commence until official notification is received from the department.
The form collects applicant data regarding LGBTQ ownership and certification status, which may be relevant for diversity tracking, set-aside programs, or reporting requirements at the state or local level. This demographic information gathering is a standard component of many government procurement processes designed to monitor participation and opportunities for LGBTQ-owned businesses. The specific pricing terms, contract duration, and other financial requirements would be detailed in the primary solicitation documents, while this form focuses exclusively on applicant classification and eligibility verification for LGBTQ-related preferences or tracking purposes.
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Other files
| File | Type | Posted |
|---|---|---|
| Consent_Authorization_B1801234~26.pdf | ||
| MP_Terms_and_Conditions_B1801234~17.pdf | ||
| Seller_SP_Checklist_B1801234~21.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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